Antibiotic Coverage for Enterococcus faecium

Treatment Algorithm Based on Susceptibility Pattern

The American Heart Association recommends vancomycin 30 mg/kg per 24 hours IV in 2 equally divided doses for 6 weeks for vancomycin-susceptible, ampicillin-resistant E. faecium endocarditis, with a strength of evidence of Class IIa and Level of Evidence B 2
For vancomycin-susceptible, ampicillin-resistant E. faecium, the American Heart Association suggests adding gentamicin 3 mg/kg per 24 hours IV or IM in 3 equally divided doses for synergistic activity in serious infections like endocarditis, with a strength of evidence of Class IIa and Level of Evidence B 2
The American College of Cardiology recommends linezolid 600 mg IV or PO every 12 hours for at least 6 weeks for serious infections like endocarditis caused by vancomycin-resistant E. faecium, with a cure rate of 77% 1
For vancomycin-resistant E. faecium, the American Heart Association recommends daptomycin 10-12 mg/kg/day IV as an alternative, particularly for bacteremia and serious infections requiring bactericidal activity 2

For uncomplicated urinary tract infections, the American Urological Association recommends fosfomycin 3 g PO single dose or nitrofurantoin 100 mg PO every 6 hours for 3-7 days 1
For intra-abdominal infections, the Infectious Diseases Society of America suggests tigecycline 100 mg IV loading dose, then 50 mg IV every 12 hours when standard agents have failed 1

The American Heart Association advises monitoring for bone marrow suppression, peripheral and optic neuropathy, and drug interactions when using linezolid 2, 1
The American College of Cardiology recommends monitoring creatine phosphokinase levels for myopathy and watching for intractable muscle pain as a treatment-limiting adverse effect when using daptomycin 2, 3

The Infectious Diseases Society of America recommends treatment duration of 7-14 days for uncomplicated infections, 10-14 days for bacteremia, and at least 6 weeks for endocarditis 1, 2

The American Academy of Pediatrics suggests infectious disease consultation as the standard of care for pediatric enterococcal infections 4