Nitrofurantoin Dosing for UTI Caused by Enterococcus faecalis

Recommended Dosing Regimen for Enterococcus UTIs

For uncomplicated UTIs due to vancomycin-resistant enterococci (VRE), nitrofurantoin 100 mg PO every 6 hours is recommended (Weak recommendation, very low quality of evidence) 1, 2
For standard uncomplicated UTIs not specifically caused by enterococci, the more common dosing is nitrofurantoin monohydrate/macrocrystals 100 mg twice daily for 5 days 3

Nitrofurantoin is contraindicated in patients with creatinine clearance <60 mL/min due to inadequate urinary drug concentrations and increased toxicity risk 4
For patients with renal impairment, alternative agents such as trimethoprim-sulfamethoxazole or fosfomycin should be considered 4
Common side effects include nausea and headache, with adverse event rates ranging from 5.6-34% 3
Nitrofurantoin should be avoided if early pyelonephritis is suspected 3

While the standard duration for uncomplicated UTIs is 5-7 days 3, for enterococcal UTIs specifically, treatment should be continued until clinical resolution, typically 7-10 days 1
Clinical cure rates with nitrofurantoin range from 88-93% for uncomplicated UTIs 3

If nitrofurantoin cannot be used, fosfomycin 3 g PO as a single dose is an alternative for uncomplicated UTIs due to VRE 1
High-dose ampicillin (18-30 g IV daily in divided doses) or amoxicillin 500 mg IV or PO every 8 hours are other alternatives for uncomplicated UTIs due to VRE 1

Routine post-treatment urinalysis or urine cultures are not indicated for asymptomatic patients 3
For women whose symptoms do not resolve by the end of treatment or recur within 2 weeks, a urine culture with susceptibility testing should be performed 3