Enterococcal Infections Treatment Guidelines

Introduction to Enterococcal Infections

The American College of Microbiology recommends against using ceftaroline for enterococcal infections due to its poor activity against Enterococcus 1, 2, 3, 4
For serious enterococcal infections, the Infectious Diseases Society of America recommends daptomycin at high doses (10-12 mg/kg/day) as the preferred agent 1, 2, 3, 4

The European Society of Clinical Microbiology and Infectious Diseases suggests that daptomycin is preferred for the treatment of serious VRE infections at a dosing of at least 8 mg/kg and up to 10-12 mg/kg due to its bactericidal activity 1, 2, 3, 4
High-dose daptomycin 10-12 mg/kg/day IV produces sustained bactericidal activity and should be the standard approach for serious infections 5
Standard doses of 8 mg/kg may be insufficient for some resistant strains 1, 2, 3, 4

The American College of Microbiology suggests that ceftaroline can be used as a synergistic partner with daptomycin for resistant or persistent enterococcal infections 5
Daptomycin 10-12 mg/kg/day IV plus ceftaroline 600 mg IV every 12 hours is recommended for serious infections 5
If ampicillin-susceptible, Daptomycin 10-12 mg/kg/day IV plus ampicillin 2g IV every 6 hours (total 8g/day) is preferred over ceftaroline 5

Linezolid 600 mg PO or IV every 12 hours for 6 weeks is effective for chronic enterococcal infections with success rates of 80-86% 5
Tigecycline is appropriate for polymicrobial VRE infections in intra-abdominal settings, but should not be first-line in bacteremic patients due to poor plasma concentrations and higher risk of failing to clear bacteremia 6

Vancomycin-resistant E. faecium infections are associated with higher mortality and longer duration of bacteremia compared to vancomycin-resistant E. faecalis infections 1, 2, 3, 4
Aggressive combination therapy for E. faecium is recommended 5

Management of relapsed or resistant enterococcal infections should involve infectious disease consultation as standard of care 5
Comprehensive susceptibility testing including ampicillin/penicillin MIC determination is necessary 5
Appropriate selection of combination therapy and monitoring for treatment-related toxicities are crucial 5