Aminopenicillins for treatment of ampicillin-resistant enterococcal urinary tract infections
Bunnell K, Duong A, Ringsred T, Mian A, Bhathena S. Aminopenicillins for treatment of ampicillin-resistant enterococcal urinary tract infections [published online ahead of print, 2022 Mar 17]. Am J Health Syst Pharm. 2022;zxac068. doi:10.1093/ajhp/zxac068
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Purpose: The purpose of this review is to describe the theory behind and data supporting use of aminopenicillins in the treatment of ampicillin-resistant enterococcal urinary tract infections.
Summary: Aminopenicillin concentrations in the urine may be high enough to achieve bacterial eradication and clinical cure for infections affecting the lower genitourinary tract, even in the context of in vitro resistance based on established susceptibility breakpoints. A literature search was conducted to identify original research articles describing the use of aminopenicillins in the treatment of urinary tract infections caused by ampicillin-resistant Enterococcus species. Three published retrospective cohort studies were identified, all of which reported that aminopenicillins had similar rates of clinical cure as other antibiotic classes prescribed for the treatment of enterococcal urinary tract infections.
Conclusion: Both pharmacokinetic/pharmacodynamic principles and limited retrospective clinical data support the use of aminopenicillins in the treatment of lower urinary tract infections caused by Enterococcus species, even when the isolates have a minimum inhibitory concentration that exceeds the susceptibility breakpoint.