Treatment of Enterococcus UTI

Question

Just wondered if you could explain something for me? Page 10 of Bugs and Drugs says that Cefixime has insufficient activity against Enterococcus, but page 372 says that for a complicated UTI the treatment of choice is Cefixime (and one of the possible pathogens is Enterococcus!) I have a lady growing Enterococcus not VRE sensitive to Amp and Nitrofurantoin. As far as I can see I would not use Cefixime in this lady but this is what was ordered by the house Doc. Help please!

Answer

Great point yes the cephalosporins as a group are not effective empiric choices for enterococcus. So for the lady you talking about culture directed therapy (either amp or nitro, depending on allergies, infection location (pyelo v cystitis) and complicating factors) would be best.

As for bugs and drugs… This would be afebrile systemically well patients cefixime could be used (and miss enterococcus)as it would ‘hit’ the majority of likely causes. As for the driver of this choice I would assume it would e coli sensitivities as they typically represent the majority of urine pathogens. And you can see in febrile systemically unwell in bugs and drugs they add ampicillin to ceftriaxone for that enterococcal coverage.

Answered by Jolanta Piszczek.

Category: Urinary Tract Infections

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