Enterococcus faecalis Endocarditis and Outpatient Treatment: A Systematic Review of Current Alternatives

Area of Science:

• Infectious Diseases
• Cardiology
• Pharmacology

Background:

• Enterococcus faecalis infective endocarditis (IE) requires effective continuation treatment in outpatient settings.
• Selecting optimal outpatient therapies for E. faecalis IE is challenging due to varied evidence.
• Current treatment guidelines require evaluation for outpatient suitability.

Purpose of the Study:

• To examine antibiotic treatment alternatives for Enterococcus faecalis infective endocarditis (IE) suitable for outpatient settings.
• To synthesize evidence on the efficacy and outpatient adaptability of various IE treatment regimens.
• To identify promising therapies for E. faecalis IE continuation treatment.

Main Methods:

• Systematic literature search of three databases for antibiotic therapies against E. faecalis IE.
• Inclusion of studies reporting species-specific and regimen-based treatment data.
• Narrative synthesis of extracted data following quality assessment of study designs.

Main Results:

• Eighteen studies were included, classifying regimens by main antibiotic: aminoglycosides, dual β-lactam, teicoplanin, daptomycin, dalbavancin, or oral therapy.
• Aminoglycoside and dual β-lactam regimens demonstrated the most evidence for efficacy.
• Dual β-lactam is preferred for aminoglycoside-resistant strains and has lower nephrotoxicity, but outpatient adaptation is poorly documented; other regimens show promise for outpatient use.

Conclusions:

• Aminoglycoside and dual β-lactam regimens are the most evidenced options for Enterococcus faecalis IE.
• Dual β-lactam is a viable alternative for resistant strains, though its outpatient use needs more study.
• Teicoplanin, dalbavancin, and oral therapies show promise for outpatient E. faecalis IE, but insufficient evidence currently prevents general recommendations.