From the Guidelines
For vaginal Enterococcus faecalis infection, Nitrofurantoin (Macrobid) can be prescribed at 100 mg orally twice daily for 5-7 days, as it has shown good in vitro activity against VREs 1. The treatment duration may vary depending on the severity of the infection, with uncomplicated infections typically requiring a 5-day course and complicated infections requiring 7 days of treatment. It is essential to note that the provided evidence does not directly address the treatment of vaginal Enterococcus faecalis infections with Macrobid, but rather focuses on the treatment of urinary tract infections and other types of infections caused by VREs. However, based on the available information, Macrobid can be considered a viable option for the treatment of vaginal Enterococcus faecalis infections, given its efficacy against VREs in urinary tract infections 1. Some key points to consider when prescribing Macrobid include:
- Ensuring adequate renal function before prescribing, as the drug is contraindicated in patients with creatinine clearance <30 mL/min
- Advising patients to take the medication with food to enhance absorption and reduce gastrointestinal side effects
- Completing the entire course of antibiotics, even if symptoms improve before completion
- Monitoring for common side effects, such as nausea, headache, and urine discoloration
- Encouraging patients to stay well-hydrated during treatment. It is crucial to consult with an infectious disease specialist for patients with poor treatment response or when longer duration of treatment is considered, as the treatment of VRE infections can be complex and may require individualized approaches 1.
From the Research
Vaginal Enterococcus faecalis Treatment with Macrobid
- The recommended treatment for aerobic vaginitis (AV) caused by Enterococcus faecalis includes a combination of therapy such as antibacterial, hormonal, non-steroidal anti-inflammatory, and/or probiotics 2.
- Local antibiotics, preferably non-absorbed and broad-spectrum, may be used to treat AV, but there is no specific mention of Macrobid (nitrofurantoin) in the context of treating Enterococcus faecalis in the provided studies 3.
- However, one study found that vancomycin-resistant Enterococcus faecalis isolates were >90% susceptible to nitrofurantoin, suggesting that Macrobid may be effective against this type of infection 4.
- The dosage and duration of Macrobid for treating vaginal Enterococcus faecalis are not specified in the provided studies.
- It is essential to note that the treatment of AV should be based on microscopic or microbiological findings, and a combination of therapies may be necessary to achieve the best results 2, 3.
Considerations for Treatment
- The choice of antibiotic should be based on the susceptibility profile of the isolated pathogen, and Macrobid may be considered for urinary tract infections secondary to vancomycin-resistant E. faecalis 4.
- The treatment of AV requires a comprehensive approach, including addressing the underlying causes of the infection, such as hormonal imbalances or epithelial atrophy, and not just treating the symptoms 2, 3.