Treatment of Chronic Prostatitis Caused by Enterococcus faecalis

First-Line Treatment Options

• The American Heart Association recommends an ampicillin-based regimen for patients with Enterococcus faecalis infections, if susceptible 1, 2

Alternative Therapies

• For aminoglycoside-susceptible strains, combination therapy with ampicillin plus gentamicin is recommended 3, 2
• For fluoroquinolone-resistant E. faecalis, a double β-lactam regimen of ampicillin 2g IV every 4 hours plus ceftriaxone 2g IV every 12 hours for 6 weeks is effective 1
• Vancomycin combined with gentamicin for 6 weeks is recommended for penicillin-allergic patients, if aminoglycoside-susceptible 3, 2

Special Considerations

• Gentamicin dosing should be adjusted to achieve 1-hour serum concentration of ~3 μg/mL and trough <1 μg/mL 4, 2
• Aminoglycosides should be avoided in patients with creatinine clearance <50 mL/min due to nephrotoxicity risk 4, 1

Treatment of Resistant Strains

• Infectious disease consultation is strongly recommended for management of resistant strains 3
• Newer agents like daptomycin may be considered for multi-drug resistant strains, though data is limited 2