Cefuroxime Ineffectiveness Against Enterococcus UTIs

Enterococcus Susceptibility to Cefuroxime

When treating infections that might involve Enterococcus, ampicillin is often added to regimens to provide enterococcal coverage that would otherwise be lacking 1

Ampicillin remains the drug of choice for enterococcal infections, including UTIs 2, 3
Fosfomycin is FDA approved for UTIs caused by E. faecalis and has demonstrated in vitro activity against enterococci 3
Nitrofurantoin has good in vitro activity against enterococci and can be used for lower urinary tract infections 3
Linezolid 600 mg IV or PO every 12 hours is recommended for enterococcal infections 4
High-dose daptomycin (8-12 mg/kg IV daily), alone or in combination with β-lactams, is recommended for serious VRE infections 2
A single dose of fosfomycin 3g PO is recommended for uncomplicated urinary tract infections due to VRE 4

When empirically treating complicated UTIs where enterococci might be involved, cefuroxime should not be used as monotherapy 5
The microbial spectrum in complicated UTIs is broader than in uncomplicated UTIs, with Enterococcus spp. being among the common species found in cultures 6
Empiric regimens for complicated UTIs that may involve enterococci should include agents with enterococcal activity, such as ampicillin (potentially combined with an aminoglycoside) 6

For uncomplicated pyelonephritis: fluoroquinolones, trimethoprim-sulfamethoxazole, or oral cephalosporins like cefpodoxime or ceftibuten 6
For complicated UTIs requiring hospitalization: fluoroquinolones, aminoglycosides (with or without ampicillin), extended-spectrum cephalosporins, or piperacillin-tazobactam 5
When enterococcal coverage is specifically needed, ampicillin or amoxicillin should be included in the regimen 1, 3