Antibiotic Treatment for Enterococcus UTI

First-Line Treatment

The American College of Physicians recommends ampicillin or amoxicillin 500 mg orally every 8 hours for 7 days as the first-line treatment for uncomplicated Enterococcus UTI, with clinical cure rates of 88.1% and microbiological eradication of 86% 1
Fosfomycin 3 g orally as a single dose is FDA-approved specifically for E. faecalis UTI and is recommended for uncomplicated infections 2, 3, 1
Nitrofurantoin 100 mg orally every 6 hours for 7 days is an effective alternative with resistance rates below 6% in E. faecalis 2, 3, 1

Linezolid 600 mg IV every 12 hours for 5-7 days is strongly recommended for complicated enterococcal UTI 2, 3
High-dose ampicillin 18-30 g IV daily in divided doses is recommended for hospitalized patients requiring IV therapy 2, 3, 1
Daptomycin 6-12 mg/kg IV daily for 5-7 days is an alternative for complicated UTI 3

Fosfomycin 3 g orally single dose or every other day is recommended for uncomplicated VRE UTI 2, 3
Nitrofurantoin 100 mg orally four times daily for 3-7 days is recommended for uncomplicated VRE UTI 2, 3
High-dose ampicillin 18-30 g/day IV in divided doses is recommended despite resistance, due to urinary concentration 2, 3

The Infectious Diseases Society of America recommends obtaining susceptibility testing before initiating therapy, even for strains described as "pansensitive" 1
The European Urology Association notes that antimicrobial resistance is more likely in complicated UTIs, which include E. coli, Proteus, Klebsiella, Pseudomonas, Serratia, and Enterococcus species 4

The Journal of Microbiology, Immunology and Infection recommends treatment duration of 3-7 days for uncomplicated lower UTI, 5-7 days for complicated UTI, and 7-14 days for pyelonephritis 2, 3, 4
Treatment duration should be based on clinical response, site of infection, source control, underlying comorbidities, and initial response to therapy 2, 3