Vancomycin-resistant enterococcus
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Background
- Enterococcus is part of normal gut flora
- Must cover both Enterococcus faecium and Enterococcus faecalis
Antimicrobial Options[1][2]
- Gentamicin 1 mg/kg q8hrs IV
- Use streptomycin for gentamicin resistance
- Add ampicillin 12 g q24hrs IV if treating endocarditis or vancomycin if suspicious for MRSA
- Linezolid 600 mg PO/IV q12hrs
- Daptomycin 6 mg/kg q24hrs
- Cannot be used for pulmonary infection
- Daptomycin is inactivated by surfactant by in vitro studies
Sources
- ↑ Arias CA et al. Management of multidrug-resistant enterococcal infections. Clin Microbiol Infect. 2010 Jun; 16(6): 10.1111/j.1469-0691.
- ↑ Rivera AM and Boucher HW. Current Concepts in Antimicrobial Therapy Against Select Gram-Positive Organisms: Methicillin-Resistant Staphylococcus aureus, Penicillin-Resistant Pneumococci, and Vancomycin-Resistant Enterococci. Mayo Clin Proc. 2011 Dec; 86(12): 1230–1243.