From the FDA Drug Label
Meropenem for injection, USP (I.V.) is indicated for the treatment of complicated skin and skin structure infections (cSSSI) due to ... Enterococcus faecalis (vancomycin-susceptible isolates only) ...
Meropenem covers Enterococcus faecalis, but only for vancomycin-susceptible isolates.
- Key points:
- Meropenem is effective against vancomycin-susceptible Enterococcus faecalis.
- The coverage is specific to complicated skin and skin structure infections.
- The drug label does not provide information on the effectiveness of meropenem against vancomycin-resistant Enterococcus faecalis 1.
From the Research
Meropenem, in combination with ceftaroline, has been shown to be effective against Enterococcus faecalis, and may be considered as an alternative treatment option for serious E. faecalis infections. According to a recent study published in 2022 2, meropenem plus ceftaroline demonstrated significant kill against E. faecalis isolates, with no regrowth or MIC increases occurring. This combination therapy may provide clinicians with another regimen to treat severe E. faecalis infections. However, it's essential to note that meropenem alone may not provide reliable coverage against E. faecalis due to the organism's intrinsic resistance to carbapenems, which is attributed to its low-affinity penicillin-binding proteins (PBPs) 3.
Some key points to consider when treating E. faecalis infections include:
- Ampicillin or penicillin is typically the first choice for susceptible strains, often at doses of 2g IV every 4-6 hours for serious infections.
- For penicillin-allergic patients or resistant strains, vancomycin (15-20 mg/kg IV every 8-12 hours) is commonly used.
- In severe infections like endocarditis or meningitis, combination therapy with an aminoglycoside (such as gentamicin) may be added for synergistic effects.
- The choice of antibiotic should be guided by susceptibility testing and clinical experience, as the efficacy of different regimens can vary depending on the specific strain and infection site.
It's also worth noting that a more recent study published in 2023 4 found that meropenem plus ceftriaxone or ertapenem plus ceftriaxone demonstrated consistent synergistic activity against E. faecalis isolates, highlighting the potential benefits of combination therapy in treating these infections. However, the study also emphasized the importance of understanding the PBP profiles of E. faecalis strains to better inform beta-lactam options for treatment.
Overall, while meropenem alone may not be the most effective option for treating E. faecalis infections, combination therapy with ceftaroline or other beta-lactams may provide a viable alternative for serious infections.