Treatment of Vancomycin-Resistant Enterococci and Extended-Spectrum Beta-Lactamase Urinary Tract Infections

Vancomycin-Resistant Enterococci Urinary Tract Infections

• The Infectious Diseases Society of America recommends fosfomycin 3g PO as a single dose or nitrofurantoin 100mg PO every 6 hours for 5 days as first-line therapy for uncomplicated VRE cystitis, with excellent urinary concentrations and sustained activity against VRE 1
• For complicated VRE UTI or suspected upper tract infection, linezolid 600mg IV or PO every 12 hours is recommended, achieving excellent urinary concentrations and strong evidence with cure rates of 67% in high-dose regimens 1
• Treatment duration should be 10-14 days for pyelonephritis, as recommended by the Infectious Diseases Society of America 1
• Daptomycin 8-12mg/kg IV daily is reserved for bacteremic VRE UTI or when linezolid cannot be used, with higher doses (10-12mg/kg) preferred for serious infections, as suggested by the American College of Clinical Pharmacy 2

Alternative Therapies

• The American College of Clinical Pharmacy suggests that higher doses (10-12mg/kg) of daptomycin are preferred for serious infections 2
• Monitor creatine kinase levels with high-dose daptomycin, as recommended by the American College of Clinical Pharmacy 3
• The Infectious Diseases Society of America advises against using tigecycline for VRE bacteremia or suspected upper tract infection due to poor serum concentrations despite large volume of distribution 3