NB: Our Prostatitis PID Clinic Doctors are experts in dealing with Enterococci (primarily: faecalis, faecium) genitourinary infections.
They are common organisms in the intestines of humans: E. faecalis (90-95%) and E. faecium (5-10%), however outside that environment they can cause havoc, including urinary tract infections, bacterial endocarditis (damaging heart valves), diverticulitis, and meningitis. They are very hardy and can survive in unforgiving environments.
Sensitive strains of these bacteria can be treated with ampicillin and vancomycin and urinary tract infections are commonly treated with nitrofurantoin. Non-urinary tract infections commonly warrant a multi-drug approach. They are naturally resistant to many antibiotics and are serious infectious agents in chronic bacterial prostatitis. Enterococci are able to make biofilms in the prostate and elsewhere, making for difficult eradication.
In summary, enterococci are a common pathogen wreaking havoc in the human genitourinary system. Immediate treatment is called for, and after a time, a positive culture may be difficult to achieve. They then have the ability to migrate around the body with the possibility of causing serious damage.
If you've had a positive culture of enterococcus and drugs have failed to kill it, consult a urologist or infectious diseases specialist for a multidrug approach. Here's a rundown of drugs used to treat Enterococcus faecalis; normal approach; for resistant cases; a multi-drug approach. You can read more about each drug by following the links..
First, get used to the term "VRE", because you'll hear it a lot. Because of frequent use of Vancomycin, many isolates of enterococcus species are resistant, and this has led to a serious treatment problem primarily in North America.
Urinary tract infections are usually treated with a single antibiotic. Ampicillin is the drug of choice for single drug therapy of susceptible Enterococcus faecalis infection. For most isolates, the MIC of ampicillin is 2 to 4-fold lower than that of penicillin.
For rare strains that are resistant to ampicillin because of beta-lactamase production, ampicillin + sulbactam may be used.
Vancomycin should be used in patients with a penicillin allergy or infections with strains that have penicillin resistance.
Nitrofurantoin is effective for urinary tract infections, including many (VRE) strains.
Linezolid, tigecycline, daptomycin are options to treat VRE infections.
Substitution for Resistant enterococcal strains
The emergence of enterococcal strains with multidrug-resistant ability has complicated the management of enterococcal infections.
- Vancomycin should be used to treat infections with strains that exhibit high-level resistance to ampicillin.
- For gentamicin-resistant strains, the alternative is streptomycin, as tobramycin and amikacin are not active.
- For E faecalis infection, lengthy application of high doses of ampicillin + ceftriaxone and ampicillin + imipenem-cilastatin are options.
- For E faecium infection, either daptomycin or linezolid may be effective, and tigecycline or quinupristin-dalfopristin are a possibility.
- Doxycycline, rifampin and chloramphenicol combinations have been used to treat VRE infections, but there are newer antibiotic options.
Newer Drug Choice options for Resistant Enterococcal Infections
- Linezolid, (an oxazolidinone), is available orally and intravenously and is used to treat infections caused by E faecium and E faecalis strains, including VRE. Linezolid-resistant VRE strains have been recorded.
- Daptomycin may be the only drug with activity against enterococci as a sole antibiotic therapy. Resistance in VRE strains has been recorded.
- Tigecycline, (a glycylcycline) can be used to treat gram-positive and gram-negative and anaerobic bacterial infections. It can be used to treat vancomycin-sensitive E faecalis infections.
- Dalbavancin is related to vancomycin and teicoplanin. It is effective especially for MRSA infections but has activity against non-VRE enterococci. It has a very long half-life, (weekly dosing).
- Oritavancin (a glycopeptide) is active against all gram-positive pathogens, including VRE. It has activity against bacteria embedded in biofilms, and a low adverse drug reaction.
Treatment Choices for a Chronic Prostatitis patient diagnosed with Enterococcus faecalis
A Chronic Prostatitis patient should pay close attention to the above drug choice information. Drug treatment of resistant strains may become difficult, and a medical specialist may not have a lot of experience with E. faecalis.
The important difference at our Chronic Prostatitis & PID Clinic is that we can place the correct drug(s) directly where the infection is, through injection. This results in far higher concentrations of the drugs involved, and therefore the best possibility of complete eradication of the pathogen before resistance can set in.
Have a read of our unique techniques in eradicating enterococcus in our chronic prostatitis patients, and be sure to make use of our free Prostatitis consultation.
If you have any comments which will help our readers, you can submit them below..
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715713/ accessed 12 Jun 2014
http://www.emedicinehealth.com/prostate_infections/page3_em.htm accessed 23 Jun 2014
http://en.wikipedia.org/wiki/Enterococcus accessed 21 Jul 2014
http://emedicine.medscape.com/article/216993-overview accessed 1 Aug 2014