Ceftaroline for Enterococcus faecium Infections
No, ceftaroline does not work as monotherapy for Enterococcus faecium infections, including vancomycin-resistant strains, and should not be used alone for this indication. 1, 2
Activity Profile Against Enterococci
Ceftaroline has limited to no activity against E. faecium and should be avoided as monotherapy for these infections 1, 2, 3:
- Ceftaroline demonstrates activity against vancomycin-resistant E. faecalis but not against E. faecium 2, 3
- The drug has poor intrinsic activity against E. faecium, making it unsuitable as a primary treatment option 1
- E. faecium infections are associated with higher mortality and longer duration of bacteremia compared to E. faecalis, requiring aggressive therapy 1
Potential Role in Combination Therapy
While ceftaroline monotherapy fails against E. faecium, it may have a role as a synergistic partner with daptomycin for resistant or persistent enterococcal infections 1:
- The combination of daptomycin 10-12 mg/kg/day IV plus ceftaroline 600 mg IV every 12 hours can be considered for serious infections when other options are limited 4, 1
- The American Heart Association states that ceftaroline in combination with daptomycin demonstrates synergistic activity for enterococcal infections 4
- This combination should be reserved for multidrug-resistant cases or treatment failures, not as first-line therapy 5, 4
Recommended Treatment Alternatives
For serious E. faecium infections, particularly vancomycin-resistant strains, use these evidence-based options instead 5, 1:
- Daptomycin 10-12 mg/kg/day IV is the preferred agent for serious VRE infections, with mandatory weekly CPK monitoring 5, 1
- Linezolid 600 mg IV or PO every 12 hours is recommended with success rates of 80-86%, though requires weekly CBC monitoring for myelosuppression after 2 weeks 5, 1
- Tigecycline (100 mg IV loading dose, then 50 mg IV every 12 hours) for intra-abdominal VRE infections, though it should not be first-line in bacteremic patients due to poor plasma concentrations 5
Critical Management Principles
Infectious disease consultation is mandatory for all serious E. faecium infections as standard of care 5, 4, 1:
- Obtain comprehensive susceptibility testing including ampicillin/penicillin MIC determination, vancomycin susceptibility, and high-level gentamicin resistance 4
- For beta-lactam susceptible strains, daptomycin 10-12 mg/kg/day plus ampicillin 2g IV every 6 hours is preferred over ceftaroline combinations 4, 1
- Combination therapy becomes especially critical when daptomycin MICs are ≥3 μg/mL within the susceptible range 4