From the Guidelines
Augmentin (amoxicillin-clavulanate) is not reliably effective against enterococci, and its use is not recommended as a first-line treatment for enterococcal infections. The limited effectiveness of Augmentin against enterococci is due to the natural resistance mechanisms these bacteria possess, including altered penicillin-binding proteins and beta-lactamase production in some strains 1. While the clavulanic acid component of Augmentin inhibits many beta-lactamases, enterococci have additional resistance mechanisms that reduce Augmentin's reliability.
Key Points to Consider
- Enterococci, such as Enterococcus faecalis and Enterococcus faecium, have inherent resistance to many antibiotics, including Augmentin 1.
- For confirmed enterococcal infections, other antibiotics are typically preferred, such as ampicillin (for susceptible strains), vancomycin, or linezolid, depending on susceptibility testing 1.
- The treatment regimen for enterococcal infections should be guided by antimicrobial susceptibility testing rather than empirical use of Augmentin.
- In cases of vancomycin-resistant enterococci, alternative treatments such as linezolid or daptomycin may be considered, but the choice of therapy should be made in consultation with an infectious disease specialist 1.
Recommendations for Treatment
- Ampicillin or vancomycin, in combination with an aminoglycoside, is recommended for the treatment of enterococcal infections, depending on the susceptibility of the isolate 1.
- For patients with infections caused by susceptible strains of enterococci who are unable to tolerate β-lactam therapy, vancomycin combined with gentamicin is recommended 1.
- The duration of treatment should be at least 4 to 6 weeks, depending on the severity of the infection and the presence of any complications 1.
From the Research
Antibiotic Coverage for Enterococci
- Augmentin, a combination of amoxicillin and clavulanic acid, has been studied for its effectiveness against enterococci 2, 3.
- According to the studies, amoxicillin is preferred over other agents when enterococci are susceptible and patients can tolerate it 2, 3.
- However, the effectiveness of Augmentin against enterococci can be limited by resistance mechanisms, such as those found in vancomycin-resistant enterococci (VRE) 4.
- The use of amoxicillin, which is a component of Augmentin, has been associated with better outcomes in patients with enterococcal bacteraemia 3.
- It is essential to note that the susceptibility of enterococci to Augmentin can vary depending on the specific species and strain of the bacteria, as well as the patient's individual characteristics and medical history 5.
Specific Enterococcal Species and Augmentin
- Enterococcus faecalis and E. faecium are commonly encountered species, and Augmentin may be effective against these bacteria when they are susceptible 2, 3.
- However, other species, such as Enterococcus gallinarum and E. casseliflavus/flavescens, may exhibit intrinsic resistance to vancomycin and other antibiotics, limiting the effectiveness of Augmentin 4.
- The use of Augmentin against these resistant species may require careful consideration of the patient's individual circumstances and the potential need for alternative or combination therapies 4, 3.
Clinical Implications and Recommendations
- The choice of antibiotic therapy for enterococcal infections should be guided by susceptibility testing and clinical judgment, taking into account the patient's medical history, the severity of the infection, and the potential for resistance 2, 3, 5.
- Augmentin may be a suitable option for the treatment of enterococcal infections when the bacteria are susceptible, but it is crucial to monitor for potential resistance and adjust the treatment plan accordingly 3, 5.