From the Guidelines
Enterococcus faecalis coverage is typically achieved with ampicillin 2 grams intravenously every 4 hours or penicillin G 3-4 million units intravenously every 4 hours 1. Alternative therapies for patients with penicillin allergy or resistance include linezolid 600 mg orally or intravenously every 12 hours or daptomycin 4-6 mg/kg intravenously every 24 hours 1.
- Key considerations for treatment include:
- The use of vancomycin in combination with gentamicin for patients with penicillin-resistant strains 1
- The potential need for streptomycin in certain cases, such as when gentamicin is not effective 1
- The importance of monitoring serum levels and adjusting dosages as needed to ensure effective treatment and minimize toxicity 1
- Treatment duration typically ranges from 4-6 weeks for endocarditis, depending on the severity and site of infection, as well as the patient's response to treatment 1.
- For uncomplicated cases, such as catheter-related bloodstream infections, treatment duration may be shorter, typically 7-14 days 1.
From the FDA Drug Label
Daptomycin has been shown to be active against most isolates of the following microorganisms both in vitro and in clinical infections [see Indications and Usage (1)] Gram-Positive Bacteria Enterococcus faecalis (vancomycin-susceptible isolates only)
Daptomycin has antibiotic coverage for Enterococcus faecalis, but only for vancomycin-susceptible isolates 2.
From the Research
Antibiotic Coverage for Enterococcus faecalis
The antibiotic coverage for Enterococcus faecalis includes:
- Ampicillin plus ceftriaxone, which has been shown to be effective in treating E. faecalis endocarditis, including cases with high-level aminoglycoside resistance 3, 4
- Quinupristin/dalfopristin, which has bacteriostatic activity against vancomycin-resistant E. faecium, but is not active against E. faecalis 5
- Linezolid, which has bacteriostatic activity against both vancomycin-resistant E. faecium and E. faecalis 5
- Daptomycin, which has been shown to be effective in treating experimental endocarditis caused by penicillin-resistant enterococci, including E. faecalis 6
- Ampicillin plus ceftobiprole, which has been shown to be effective in treating E. faecalis invasive infections, with a high clinical success rate and microbiological cure rate 7
Key Findings
- The combination of ampicillin and ceftriaxone has been shown to be effective and safe for treating E. faecalis endocarditis, including cases with high-level aminoglycoside resistance 3, 4
- Linezolid has been shown to be effective in treating vancomycin-resistant E. faecium and E. faecalis infections, with a high cure rate and low incidence of adverse effects 5
- Daptomycin has been shown to be effective in treating experimental endocarditis caused by penicillin-resistant enterococci, including E. faecalis, and may be a useful alternative to traditional antibiotic regimens 6
- The combination of ampicillin and ceftobiprole has been shown to be effective in treating E. faecalis invasive infections, with a high clinical success rate and microbiological cure rate 7