Antibiotic Coverage for Corynebacterium and E. faecalis

Introduction to Antibiotic Coverage

The American College of Physicians and Infectious Diseases Society of America recommends vancomycin as the drug of choice for Corynebacterium species, while ampicillin remains first-line therapy for E. faecalis when susceptible, with vancomycin, piperacillin-tazobactam, or linezolid as alternatives based on resistance patterns and infection severity 1, 2

For susceptible E. faecalis in community settings, the Infectious Diseases Society of America recommends ampicillin as the drug of choice, which can be used at standard doses for most infections 1, 2, 4
Piperacillin-tazobactam provides effective coverage and can be used as an alternative based on susceptibility testing 1, 2
For healthcare-associated or resistant E. faecalis, the Infectious Diseases Society of America recommends empiric anti-enterococcal therapy, with linezolid 600 mg IV or PO every 12 hours strongly recommended for enterococcal infections, particularly when vancomycin resistance is present 5
Vancomycin remains an option for vancomycin-susceptible E. faecalis based on susceptibility testing 1, 2

For intra-abdominal infections with polymicrobial flora, tigecycline (100 mg IV loading dose, then 50 mg IV every 12 hours) is recommended for polymicrobial infections including VRE 5, 6, 7
For uncomplicated urinary tract infections due to VRE, single-dose fosfomycin 3 g PO is recommended 5
Nitrofurantoin 100 mg PO every 6 hours provides effective coverage for uncomplicated urinary tract infections due to VRE 5, 3

The Infectious Diseases Society of America advises against using ceftaroline for VRE due to its poor activity against enterococci 4, 3
Differentiating colonization from true infection is crucial before initiating anti-VRE therapy to prevent unnecessary broad-spectrum coverage and further resistance 4, 3
Empiric enterococcal coverage is not recommended for community-acquired intra-abdominal infections unless specific risk factors are present 6, 7, 1