Treatment of Urinary Tract Infections Caused by Enterococcus faecalis

First-Line Treatment Options

The American College of Physicians recommends amoxicillin 500 mg orally every 8 hours for 7 days as the first-line treatment for uncomplicated urinary tract infections caused by Enterococcus faecalis, with high clinical (88.1%) and microbiological (86%) eradication rates 1, 2
Ampicillin 500 mg orally every 8 hours for 7 days is an equivalent alternative to amoxicillin with similar efficacy 1, 2
For inpatients requiring IV therapy, the Infectious Diseases Society of America recommends ampicillin 2 g IV every 4 hours 3

Fosfomycin 3 g as a single oral dose is FDA-approved specifically for E. faecalis UTIs and offers convenient single-dose therapy 4, 2
Nitrofurantoin 100 mg orally every 6 hours for 7 days is an effective alternative with good in vitro activity against E. faecalis and low resistance rates 4, 1

For VRE UTIs, the Infectious Diseases Society of America recommends a single dose of fosfomycin 3 g PO for uncomplicated UTIs 4, 5
Nitrofurantoin 100 mg PO every 6 hours for uncomplicated UTIs is also recommended for VRE UTIs 4, 5

The Centers for Disease Control and Prevention recommends confirming susceptibility testing before initiating therapy, even for strains described as "pansensitive" 1, 2
The American College of Physicians advises avoiding fluoroquinolones due to high resistance rates (46-47% for ciprofloxacin/levofloxacin) and unfavorable risk-benefit profile for uncomplicated UTIs 2

For complicated UTIs or pyelonephritis, the Infectious Diseases Society of America recommends longer treatment durations may be necessary 1
For patients with severe infections with bacteremia, the Infectious Diseases Society of America recommends considering high-dose daptomycin (8-12 mg/kg/day) for VRE strains 4, 5

Obtain urine culture and susceptibility testing 5
For uncomplicated UTI with susceptible E. faecalis, the American College of Physicians recommends first choice: Amoxicillin or ampicillin 500 mg PO every 8 hours for 7 days 1, 2
For VRE UTI, the Infectious Diseases Society of America recommends uncomplicated: Fosfomycin 3 g single dose or nitrofurantoin 100 mg PO every 6 hours 4, 5