Treatment of E. coli Superinfection During Enterococcus Faecalis Chronic Bacterial Prostatitis Therapy

Rationale for Sequential Therapy

For enterococcal infections, ampicillin (or amoxicillin) should be given for one to two weeks intravenously followed by oral therapy with amoxicillin, with total treatment duration of 6 weeks considered sufficient after implant removal or source control 1
Premature discontinuation of amoxicillin risks relapse of the enterococcal infection, which has proven extremely difficult to eradicate over the past year 1
Fluoroquinolones should only be started after debridement and when wounds are dry, because of selection of resistance to fluoroquinolones when bioburden is high 2, 1
Fluoroquinolone monotherapy against certain organisms is not recommended because of rapid emergence of resistance and high treatment failure rates 2, 1

Obtain repeat urine cultures at the end of the 6-week amoxicillin course before starting levofloxacin to confirm E. faecalis eradication and reassess E. coli presence 1
If clinical deterioration occurs during the final 2 weeks of amoxicillin (fever, worsening symptoms, sepsis), this would necessitate immediate addition or switch to levofloxacin 1

This recommendation assumes the patient remains clinically stable with continued improvement on amoxicillin 1