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Combatting resistant enterococcal infections: a pharmacotherapy review
Nicholas J Mercuro1,2, Susan L Davis1,2, Marcus J Zervos3,4
1a Pharmacy Services, Eugene Applebaum College of Pharmacy and Health Sciences , Wayne State University , Detroit , MI , USA.
Expert Opinion on Pharmacotherapy
|June 8, 2018
Summary
Enterococci are increasingly problematic pathogens. This review details antibiotic options for treating infections caused by both susceptible and resistant enterococci, guiding appropriate clinical use.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Enterococci have transitioned from commensals to significant pathogens.
- Antibiotic resistance in enterococci presents a critical challenge in clinical practice.
- Limited therapeutic options are available for treating resistant enterococcal infections.
Purpose of the Study:
- To review antibiotics with activity against Enterococcus faecalis and Enterococcus faecium.
- To discuss mechanisms of resistance, pharmacokinetic/pharmacodynamic principles, and in vitro combinations.
- To analyze clinical studies of enterococcal infections in various body sites.
Main Methods:
- Literature review of antibiotics targeting enterococci.
- Analysis of resistance mechanisms and antimicrobial properties.
- Evaluation of clinical data for different infection types.
Main Results:
- Aminopenicillins are preferred for susceptible strains.
- Daptomycin and linezolid show efficacy against vancomycin-resistant enterococci (VRE).
- Specific agents like amoxicillin, nitrofurantoin, and fosfomycin are suitable for cystitis.
Conclusions:
- Appropriate antibiotic selection is crucial for managing enterococcal infections.
- Synergistic combinations may be needed for complex or severe infections.
- Newer agents like tedizolid and oritavancin show promise but require further clinical validation.
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