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Do Aminopenicillins Have a Role in Treating Ampicillin-Resistant Enterococcus UTIs?

Armani M Hawes1, Pranita D Tamma2, Navaneeth Narayanan3,4

  • 1Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Open Forum Infectious Diseases
|October 20, 2025
PubMed

Insights

Aminopenicillins may remain effective for treating urinary tract infections caused by ampicillin-resistant Enterococcus species. This review integrates data to assess their continued viability in clinical practice.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Clinical Microbiology

Background:

  • Urinary tract infections (UTIs) caused by Enterococcus species present a significant clinical challenge.
  • Increasing ampicillin resistance in Enterococcus strains often leads to the exclusion of aminopenicillins from treatment regimens.

Purpose of the Study:

  • To evaluate the potential clinical utility of aminopenicillins for treating ampicillin-resistant Enterococcus infections.
  • To integrate pharmacokinetic/pharmacodynamic (PK/PD) data, clinical evidence, and risk-benefit analyses.

Main Methods:

  • Review of existing pharmacokinetic/pharmacodynamic (PK/PD) data.
  • Analysis of clinical studies and case reports.
  • Assessment of risk-benefit profiles for aminopenicillin use.

Main Results:

  • Emerging evidence suggests that aminopenicillins may retain clinical efficacy despite in vitro resistance.
  • PK/PD parameters and clinical outcomes indicate a potential for successful treatment in select cases.

Conclusions:

  • Aminopenicillins could still be a viable therapeutic option for ampicillin-resistant Enterococcus UTIs.
  • Further clinical studies are warranted to define optimal usage and patient selection criteria.
Keywords:
aminopenicillinsantimicrobial resistancebacterial infectionspharmacokinetics/pharmacodynamicsurinary tract infections

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