From the FDA Drug Label
Vancomycin has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections as described in the INDICATIONS AND USAGE section. Aerobic gram-positive microorganisms Diphtheroids Enterococci (e. g., Enterococcus faecalis) Staphylococci, including Staphylococcus aureus and Staphylococcus epidermidis (including heterogeneous methicillin-resistant strains) Streptococcus bovis Viridans group streptococci
The drug label does not specifically mention Aerococcus sensitivity to vancomycin. 1
From the Research
Aerococcus species are typically sensitive to penicillin, ampicillin, and vancomycin, making these antibiotics the first-line treatment options for Aerococcus infections. For empiric therapy, ampicillin 2g IV every 4-6 hours or penicillin G 3-4 million units IV every 4 hours is recommended, with vancomycin 15-20 mg/kg IV every 8-12 hours as an alternative for penicillin-allergic patients, as supported by studies such as 2. Treatment duration typically ranges from 2-4 weeks depending on infection severity and site.
Key Points to Consider
- Aerococcus urinae and Aerococcus sanguinicola are the most clinically relevant species, commonly causing urinary tract infections, bacteremia, and endocarditis, as noted in 3 and 4.
- These gram-positive cocci can show variable sensitivity to other antibiotics like cephalosporins, macrolides, and fluoroquinolones, so susceptibility testing is important for targeted therapy, as highlighted in 5 and 2.
- Aerococcus species have intrinsic resistance to sulfonamides and aminoglycosides, though aminoglycosides may be used synergistically with beta-lactams for severe infections like endocarditis, as discussed in 5 and 4.
- Early identification and appropriate antibiotic selection are crucial for successful treatment outcomes, particularly in elderly patients or those with underlying urological conditions who are at higher risk for these infections, as emphasized in 6.
- Nitroxoline has shown high activity against A. urinae but low activity against A. sanguinicola, suggesting its potential use in treating A. urinae urinary tract infections, as reported in 2.
Treatment Considerations
- The choice of antibiotic should be guided by susceptibility testing whenever possible.
- The duration of treatment should be tailored to the severity and site of infection.
- Combination therapy with a beta-lactam and an aminoglycoside may be considered for severe infections like endocarditis.
- Nitroxoline may be an alternative oral drug for treating A. urinae urinary tract infections, but clinical studies are needed to confirm its efficacy.