From the Guidelines
For the treatment of Enterococcus faecalis urinary tract infections (UTIs), high dose ampicillin (18-30 g IV daily in divided doses) or amoxicillin 500 mg IV or PO every 8 h daily is recommended, as per the most recent guidelines 1.
Treatment Options
- High dose ampicillin (18-30 g IV daily in divided doses) is a recommended treatment option for uncomplicated UTIs due to E. faecalis, as stated in the guidelines 1.
- Amoxicillin 500 mg IV or PO every 8 h daily is also a recommended treatment option for uncomplicated UTIs due to E. faecalis, as per the guidelines 1.
- For patients with penicillin allergies, nitrofurantoin 100 mg PO every 6 h is an alternative treatment option, although the recommendation is based on low-quality evidence 1.
- A single dose of fosfomycin 3 g PO is another option for uncomplicated UTIs due to E. faecalis, but the evidence supporting this is very low quality 1.
Considerations
- Urine cultures with susceptibility testing are essential before starting treatment to ensure appropriate antibiotic selection, as E. faecalis can exhibit resistance to multiple antibiotics.
- Patients should complete the full course of antibiotics even if symptoms improve, drink plenty of fluids, and seek follow-up care if symptoms persist.
- E. faecalis UTIs require careful management because this organism has intrinsic resistance to many commonly used antibiotics and can form biofilms that make treatment more challenging.
Key Points
- The treatment duration is dependent on the site of infection and clinical response.
- High dose daptomycin and linezolid are recommended for more severe infections, such as VRE bacteremia, but are not the first-line treatment for uncomplicated UTIs due to E. faecalis 1.
From the Research
Enterococcus faecalis UTI Treatment Options
- The treatment of Enterococcus faecalis urinary tract infections (UTIs) can be challenging due to the emergence of vancomycin-resistant strains 2, 3, 4, 5.
- Several antimicrobial agents have been studied for their efficacy against E. faecalis, including daptomycin, linezolid, quinupristin-dalfopristin, nitrofurantoin, and fosfomycin 6, 2, 3, 4, 5.
- Daptomycin has shown promising in vitro activity against E. faecalis, with minimal inhibitory concentrations (MICs) ranging up to 2 mg/l 6.
- Linezolid has also demonstrated bacteriostatic activity against E. faecalis, with MICs ranging from 2 to 4 microg/ml 2.
- Quinupristin-dalfopristin is not active against E. faecalis, but has shown efficacy against vancomycin-resistant E. faecium 2.
- Nitrofurantoin and fosfomycin are alternative options for uncomplicated E. faecalis UTIs, while daptomycin and linezolid may be reserved for more complicated or resistant infections 3, 4, 5.
Resistance and Treatment Considerations
- The emergence of vancomycin-resistant E. faecalis has limited treatment options, and the use of antimicrobial agents should be guided by urine culture and susceptibility results 4, 5.
- The removal of indwelling urinary catheters and avoidance of unnecessary antibiotic use can help prevent the development of resistant strains 4, 5.
- Combination therapy with aminoglycosides or rifampin may be considered for serious infections, but the clinical use of combined therapy remains unestablished 2, 4.
- Further studies are needed to determine the optimal management and duration of therapy for E. faecalis UTIs, particularly in the context of vancomycin resistance 3, 4, 5.