Spectrum: Local Antimicrobial Stewardship, for Fraser Health

Microbe-Specific Issues

Treatment of UTI due to Enterococcus

E. faecalis is almost universally (~99%) susceptible to ampicillin. Options include:

Amoxicillin 500 mg PO TID

Ampicillin 1 g IV q6h

Nitrofurantoin

Cystitis only, do NOT use if CrCl < 30mL/min

E. faecium is commonly resistant to vancomycin, options include:

Nitrofurantoin

Cystitis only, do NOT use if CrCl < 30mL/min

Doxycycline

Fosfomycin

Cystitis only

Linezolid

Vancomycin

If susceptibility confirmed

Treatment of UTI due to ESBL-producing organisms:

ESBLs are beta-lactamase enzymes that confer resistance to penicillins, cephalosporins, and aztreonam

If susceptible, options for therapy include:

Piperacillin-tazobactam

Acute simple cystitis only

Amoxicillin-clavulanate

Acute simple cystitis only

TMP/SMX

Ciprofloxacin

Nitrofurantoin

Acute simple cystitis only. Ineffective in pyelonephritis or bacteremia

Fosfomycin

Acute simple cystitis only. Ineffective in pyelonephritis or bacteremia