Treatment for UTI Caused by Enterococcus faecalis

First-Line Treatment Options

Fosfomycin 3g oral powder is recommended as a single dose treatment for UTIs caused by E. faecalis, due to its FDA approval and good safety profile in renal impairment, according to the Infectious Diseases Society of America 1, 2
Nitrofurantoin 100mg PO four times daily is FDA approved for lower UTIs with good activity against E. faecalis, but should be used with caution in elderly patients with eGFR 47, as stated by the American Urological Association 2
Ampicillin/Amoxicillin can be effective if susceptibility is confirmed, as ampicillin is considered the drug of choice for enterococcal infections by the Infectious Diseases Society of America 2, 3

With eGFR 47, dose adjustments may be necessary for certain antibiotics, according to the National Kidney Foundation 3
Tetracycline (since the organism is susceptible): Doxycycline 100mg twice daily can be considered, but is not a first-line agent for UTIs despite susceptibility, as stated by the American College of Physicians 1

For uncomplicated lower UTI: 3-7 days of therapy is generally sufficient, according to the American Urological Association 4
For complicated UTI (considering patient's age and renal impairment): 7 days of therapy is recommended by the European Association of Urology 5, 6
If the patient has been afebrile for at least 48 hours and is hemodynamically stable, a shorter duration may be appropriate, as stated by the European Association of Urology 5

Linezolid 600mg IV/PO every 12 hours is effective against resistant enterococci but should be reserved for more severe infections due to cost and side effect profile, according to the Infectious Diseases Society of America 2, 3
Daptomycin 6-12mg/kg IV daily can be considered for complicated UTIs if other options fail, but primarily for more serious infections, as stated by the American College of Physicians 2, 3

Differentiate between colonization and true infection before initiating therapy, according to the Infectious Diseases Society of America 2
Obtain follow-up urine cultures if symptoms persist despite appropriate therapy, as recommended by the American Urological Association 4
Avoid unnecessary prolonged use of broad-spectrum antibiotics to prevent resistance development, according to the Centers for Disease Control and Prevention 2
Consider removing indwelling catheters if present, as catheterization is a major risk factor for UTIs, as stated by the European Association of Urology 6

Treating asymptomatic bacteriuria can foster antimicrobial resistance and increase recurrent UTI episodes, according to the American Urological Association 4
Using fluoroquinolones empirically is not recommended due to high resistance rates in enterococci, as stated by the Infectious Diseases Society of America 2, 4
Prolonged therapy increases risk of resistance and adverse effects, according to the Centers for Disease Control and Prevention 2, 4
Ignoring susceptibility testing can lead to ineffective therapy, as stated by the European Association of Urology 5