Enterococcus faecalis: Difference between revisions

Enterococcus faecalis
	Enterococcus faecalis as viewed through a scanning electron microscope; Enterococcus faecalis as viewed through a scanning electron microscope
Scientific classification
Kingdom:	Bacteria;
Phylum:	Firmicutes;
Class:	Bacilli;
Order:	Lactobacillales;
Family:	Enterococcaceae;
Genus:	Enterococcus;
Species:	E. faecalis;
Binomial name
	Enterococcus faecalis; (Orla-Jensen 1919); Schleifer & Kilpper-Bälz 1984

VisualWikitext

Latest revision as of 21:07, 30 July 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Enterococcus faecalis is a Gram-positive commensal bacterium inhabiting the gastrointestinal tracts of humans and other mammals.^[1] Like other species in the genus Enterococcus, E. faecalis can cause life-threatening infections in humans, especially in the nosocomial (hospital) environment: the naturally high levels of antibiotic resistance found in E. faecalis contribute to its pathogenicity.^[1]

Pathogenesis

E. faecalis can cause endocarditis, as well as bladder, prostate, and epididymal infections; nervous system infections are less common.^[1]^[2]

E. faecalis is resistant to many commonly used antimicrobial agents (aminoglycosides, aztreonam, cephalosporins, clindamycin, the semi-synthetic penicillins nafcillin and oxacillin, and trimethoprim-sulfamethoxazole). Exposure to cephalosporins is a particularly important risk factor for colonization and infection with enterococci.

Historical Perspective

Prior to 1984, enterococci were members of the genus Streptococcus: thus E. faecalis was known as Streptococcus faecalis.^[3]

Treatment

Antimicrobial Regimen

1. Bacteremia^[4]

1.1 Ampicillin or penicillin susceptible

Preferred regimen (1): Ampicillin 2 g IV q4-6h
Preferred regimen (2): Ampicillin 2 g IV q4-6h AND Gentamicin 1 mg/kg IV/IM q8h

1.2 Ampicillin resistant and vancomycin susceptible or penicillin allergy

Preferred regimen (1): Vancomycin 15 mg/kg IV q12h AND Gentamicin 1 mg/kg IV/IM q8h
Preferred regimen (2): Linezolid 600 mg IV q12h
Preferred regimen (3): Daptomycin 6 mg/kg IV q24h

1.3 Ampicillin and vancomycin resistant

Preferred regimen (1): Linezolid 600 mg IV q12h
Preferred regimen (2): Daptomycin 6 mg/kg IV q24h

2. Endocarditis^[5]^[6]

2.1 Endocarditis in adults

2.1.1 Strains susceptible to penicillin, gentamicin, and vancomycin

Preferred regimen: (Ampicillin 12 g IV q24h for 4–6 weeks OR Aqueous crystalline penicillin G sodium 18–30 MU IV q24h for 4–6 weeks) AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 4–6 weeks
Alternative regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.

2.1.2 Strains susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin

Preferred regimen: (Ampicillin 12 g IV q24h for 4–6 weeks OR Aqueous crystalline penicillin G sodium 24 MU IV q24h for 4–6 weeks) AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 4–6 weeks
Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks

2.1.3 Strains resistant to penicillin and susceptible to aminoglycoside and vancomycin

2.1.3.1 β Lactamase–producing strain

Preferred regimen: Ampicillin-sulbactam 12 g IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h 6 weeks
Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks

2.1.3.2 Intrinsic penicillin resistance

Preferred regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks

2.1.4 Strains resistant to penicillin, aminoglycoside, and vancomycin

Preferred regimen (1): (Imipenem OR Cilastatin 2 g/day IV for ≥ 8weeks) AND Ampicillin 12 g/day IV for ≥ 8 weeks
Preferred regimen (2): Ceftriaxone sodium 4 g IV/IM q24h for ≥ 8weeks AND Ampicillin 12 g IV q24h for ≥ 8 weeks

2.2 Endocarditis in pediatrics

2.2.1 Strains susceptible to penicillin, gentamicin, and vancomycin

Preferred regimen: (Ampicillin 300 mg/kg IV q24h for 4–6 weeks OR Penicillin 0.3 MU/kg IV q24h for 4–6 weeks) AND Gentamicin 3 mg/kg IV/IM q24h 4–6 weeks
Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
Alternate regimen : Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks

2.2.2 Strains susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin

Preferred regimen: (Ampicillin 300 mg/kg IV q24h for 4–6 weeks OR Penicillin 0.3 MU/kg IV q24h for 4–6 weeks) AND Streptomycin 20–30 mg/kg IV/IM q24h for 4–6 weeks
Alternate regimen: Vancomycin hydrochloride 40 mg/kg IV q24h for 6 weeks AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks

2.2.3 Strains resistant to penicillin and susceptible to aminoglycoside and vancomycin

2.2.3.1 β Lactamase–producing strain

Preferred regimen: Ampicillin-sulbactam 300 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
Alternate regimen: Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks

2.2.3.2 Intrinsic penicillin resistance

Preferred regimen: Vancomycin 40 mg/kg IV q24h AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks

2.2.4 Strains resistant to penicillin, aminoglycoside, and vancomycin

Preferred regimen: Imipenem/Cilastatin 60–100 mg/kg IV q24h for ≥ 8 weeks AND Ampicillin 300 mg/kg IV q24h for ≥ 8 weeks
Alternate regimen: Ceftriaxone 100 mg/kg IV/IM q24h AND Ampicillin 300 mg/kg IV q24h for ≥ 8 weeks

3. Meningitis^[7]

3.1 Ampicillin susceptible

Preferred regimen: Ampicillin 12 g/day IV q4h AND Gentamicin 5 mg/kg/day IV q8h

3.2 Ampicillin resistant

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Gentamicin 5 mg/kg/day IV q8h

3.3 Ampicillin and vancomycin resistant

Preferred regimen: Linezolid 600 mg IV q12h

4. Urinary tract infections ^[8]

Preferred regimen (1): Nitrofurantoin 100 mg PO q6h for 5 days
Preferred regimen (2): Fosfomycin 3 g PO single dose
Preferred regimen (3): Amoxicillin 875 mg to 1 g PO q12h for 5 days

5. Intra abdominal or wound infections ^[9]

Preferred regimen (1): Penicillin
Preferred regimen (2): Ampicillin
Alternative regimen (Penicillin allergy or high-level Penicillin resistance): Vancomycin
Alternative regimen (For complicated skin-skin structure and intra-abdominal infection): Tigecycline 100 mg IV single dose and 50 mg IV q12h

Gallery

SEM depicts a small group of Gram-positive Enterococcus faecalis bacteria. From Public Health Image Library (PHIL). ^[10]
Enterococcus faecalis cultured on an agar plate, testing for drug sensitivity in an anaerobic environment. From Public Health Image Library (PHIL). ^[10]
SEM depicts Gram-positive Enterococcus faecalis sp. bacteria. From Public Health Image Library (PHIL). ^[10]
Quantitative difference in hemolytic reactivity seen on BAP with group-D Streptococci (left wedge), group-B Streptococci (middle wedge), and group-A Streptococci (right wedge) bacteria. From Public Health Image Library (PHIL). ^[10]

References

↑ ^1.0 ^1.1 ^1.2 Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed. ed.). McGraw Hill. pp. 294&ndash, 5. ISBN 0-8385-8529-9.
↑ Pelletier LL (1996). Microbiology of the Circulatory System. in: Baron's Medical Microbiology (Baron S et al, eds.) (4th ed. ed.). Univ of Texas Medical Branch. ISBN 0-9631172-1-1.CS1 maint: Extra text (link)
↑ Schleifer KH; Kilpper-Balz R (1984). "Transfer of Streptococcus faecalis and Streptococcus faecium to the genus Enterococcus nom. rev. as Enterococcus faecalis comb. nov. and Enterococcus faecium comb. nov". Int. J. Sys. Bacteriol. 34: 31&ndash, 34.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter |month= ignored (help)
↑ "Infective Endocarditis Diagnosis, Antimicrobial Therapy, and Management of Complications A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association".
↑ Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM; et al. (2004). "Practice guidelines for the management of bacterial meningitis". Clin Infect Dis. 39 (9): 1267–84. doi:10.1086/425368. PMID 15494903.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ ^10.0 ^10.1 ^10.2 ^10.3 "Public Health Image Library (PHIL)".

External links

Enterococcus from the Bug Index at U. of Florida

[Sherris-1] 1.0 ^1.1 ^1.2 Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed. ed.). McGraw Hill. pp. 294&ndash, 5. ISBN 0-8385-8529-9.

[Baron-2] Pelletier LL (1996). Microbiology of the Circulatory System. in: Baron's Medical Microbiology (Baron S et al, eds.) (4th ed. ed.). Univ of Texas Medical Branch. ISBN 0-9631172-1-1.CS1 maint: Extra text (link)

[Schleifer_1984-3] Schleifer KH; Kilpper-Balz R (1984). "Transfer of Streptococcus faecalis and Streptococcus faecium to the genus Enterococcus nom. rev. as Enterococcus faecalis comb. nov. and Enterococcus faecium comb. nov". Int. J. Sys. Bacteriol. 34: 31&ndash, 34.

[4] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[Baddour-2005-5] Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter |month= ignored (help)

[6] "Infective Endocarditis Diagnosis, Antimicrobial Therapy, and Management of Complications A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association".

[pmid15494903-7] Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM; et al. (2004). "Practice guidelines for the management of bacterial meningitis". Clin Infect Dis. 39 (9): 1267–84. doi:10.1086/425368. PMID 15494903.

[8] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[9] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[PHIL-10] 10.0 ^10.1 ^10.2 ^10.3 "Public Health Image Library (PHIL)".

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@@ Line 26: / Line 26: @@
 ''E. faecalis'' is resistant to many commonly used [[antimicrobial]] agents ([[aminoglycosides]], [[aztreonam]], [[cephalosporins]], [[clindamycin]], the semi-synthetic penicillins [[nafcillin]] and [[oxacillin]], and [[trimethoprim-sulfamethoxazole]]). Exposure to cephalosporins is a particularly important risk factor for colonization and infection with enterococci.
-==Historical==
+==Historical Perspective==
 Prior to 1984, enterococci were members of the genus ''[[Streptococcus]]'': thus ''E. faecalis'' was known as ''Streptococcus faecalis''.<ref name=Schleifer_1984>{{cite journal | author = Schleifer KH; Kilpper-Balz R | title = Transfer of ''Streptococcus faecalis'' and ''Streptococcus faecium'' to the genus ''Enterococcus'' nom. rev. as ''Enterococcus faecalis'' comb. nov. and ''Enterococcus faecium'' comb. nov. | journal= Int. J. Sys. Bacteriol. | year= 1984 | volume= 34 | issue= | pages= 31&ndash;34 | url= }}</ref>
+==Treatment==
+===Antimicrobial Regimen===
+:* 1. '''Bacteremia'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 1.1 '''Ampicillin or penicillin susceptible'''
+:::* Preferred regimen (1): [[Ampicillin]] 2 g IV q4-6h
+:::* Preferred regimen (2): [[Ampicillin]] 2 g IV q4-6h {{and}} [[Gentamicin]] 1 mg/kg IV/IM q8h
+::* 1.2 '''Ampicillin resistant and vancomycin susceptible or penicillin allergy'''
+:::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q12h {{and}} [[Gentamicin]] 1 mg/kg IV/IM q8h
+:::* Preferred regimen (2): [[Linezolid]] 600 mg IV q12h
+:::* Preferred regimen (3): [[Daptomycin]] 6 mg/kg IV q24h
+::* 1.3 '''Ampicillin and vancomycin resistant'''
+:::* Preferred regimen (1): [[Linezolid]] 600 mg IV q12h
+:::* Preferred regimen (2): [[Daptomycin]] 6 mg/kg IV q24h
+:* 2. '''Endocarditis'''<ref name="Baddour-2005">{{Cite journal  | last1 = Baddour | first1 = LM. | last2 = Wilson | first2 = WR. | last3 = Bayer | first3 = AS. | last4 = Fowler | first4 = VG. | last5 = Bolger | first5 = AF. | last6 = Levison | first6 = ME. | last7 = Ferrieri | first7 = P. | last8 = Gerber | first8 = MA. | last9 = Tani | first9 = LY. | title = Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal = Circulation | volume = 111 | issue = 23 | pages = e394-434 | month = Jun | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.165564 | PMID = 15956145 }}</ref><ref>{{Cite web | title =Infective Endocarditis Diagnosis, Antimicrobial Therapy, and Management of Complications A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association| url =http://circ.ahajournals.org/content/111/23/e394.full.pdf+html}}</ref>
+::* 2.1 '''Endocarditis in adults'''
+:::* 2.1.1 '''Strains susceptible to penicillin, gentamicin, and vancomycin'''
+::::* Preferred regimen: ([[Ampicillin|Ampicillin]] 12 g IV q24h for 4–6 weeks {{or}} [[Penicillin G|Aqueous crystalline penicillin G sodium]] 18–30 MU IV q24h for 4–6 weeks) {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 4–6 weeks
+::::* Alternative regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks
+::::* Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
+::::* Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
+::::* Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
+:::* 2.1.2 '''Strains susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin'''
+::::* Preferred regimen: ([[Ampicillin]] 12 g IV q24h for 4–6 weeks {{or}} [[Penicillin G|Aqueous crystalline penicillin G sodium]] 24 MU IV q24h for 4–6 weeks) {{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg IV/IM q24h for 4–6 weeks
+::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h  for 6 weeks {{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg IV/IM q24h for 6 weeks
+:::* 2.1.3 '''Strains resistant to penicillin and susceptible to aminoglycoside and vancomycin'''
+::::* 2.1.3.1 '''β Lactamase–producing strain'''
+:::::* Preferred regimen: [[Ampicillin-sulbactam]] 12 g IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h 6 weeks
+:::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks
+::::*2.1.3.2 '''Intrinsic penicillin resistance'''
+:::::* Preferred regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks
+:::*2.1.4 '''Strains resistant to penicillin, aminoglycoside, and vancomycin'''
+::::* Preferred regimen (1): ([[Imipenem]] {{or}} [[Cilastatin]] 2 g/day IV for ≥ 8weeks) {{and}} [[Ampicillin|Ampicillin]] 12 g/day IV for ≥ 8 weeks
+::::* Preferred regimen (2): [[Ceftriaxone sodium]] 4 g IV/IM q24h for ≥ 8weeks {{and}} [[ampicillin|Ampicillin]] 12 g IV q24h for ≥ 8 weeks
+::* 2.2 '''Endocarditis in pediatrics'''
+:::* 2.2.1 '''Strains susceptible to penicillin, gentamicin, and vancomycin'''
+::::* Preferred regimen: ([[Ampicillin]] 300 mg/kg IV q24h for 4–6 weeks {{or}} [[Penicillin]] 0.3 MU/kg IV q24h for 4–6 weeks) {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h 4–6 weeks
+::::* Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
+::::* Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
+::::* Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
+::::* Alternate regimen : [[Vancomycin]] 40 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h for 6 weeks
+:::* 2.2.2 '''Strains susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin'''
+::::* Preferred regimen: ([[Ampicillin]] 300 mg/kg IV q24h for 4–6 weeks {{or}} [[Penicillin]] 0.3 MU/kg IV q24h for 4–6 weeks) {{and}} [[Streptomycin]] 20–30 mg/kg IV/IM q24h for 4–6 weeks
+::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 40 mg/kg IV q24h for 6 weeks {{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg IV/IM q24h for 6 weeks
+:::* 2.2.3 '''Strains resistant to penicillin and susceptible to aminoglycoside and vancomycin'''
+::::* 2.2.3.1 '''β Lactamase–producing strain'''
+:::::* Preferred regimen: [[Ampicillin-sulbactam]] 300 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h for 6 weeks
+:::::* Alternate regimen: [[Vancomycin]] 40 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h for 6 weeks
+::::* 2.2.3.2 '''Intrinsic penicillin resistance'''
+:::::*Preferred regimen: [[Vancomycin]] 40 mg/kg IV q24h {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h for 6 weeks
+:::* 2.2.4 '''Strains resistant to penicillin, aminoglycoside, and vancomycin'''
+::::* Preferred regimen: [[Imipenem]]/[[Cilastatin]] 60–100 mg/kg IV q24h for ≥ 8 weeks {{and}} [[Ampicillin]] 300 mg/kg IV q24h for ≥ 8 weeks
+::::* Alternate regimen: [[Ceftriaxone]] 100 mg/kg IV/IM q24h {{and}} [[Ampicillin]] 300 mg/kg IV q24h for ≥ 8 weeks
+:* 3. '''Meningitis'''<ref name="pmid15494903">{{cite journal| author=Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al.| title=Practice guidelines for the management of bacterial meningitis. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 9 | pages= 1267-84 | pmid=15494903 | doi=10.1086/425368 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15494903  }}</ref>
+::* 3.1 '''Ampicillin susceptible'''
+:::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
+::* 3.2 '''Ampicillin resistant'''
+:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
+::* 3.3 '''Ampicillin and vancomycin resistant'''
+:::* Preferred regimen: [[Linezolid]] 600 mg IV q12h
+:* 4. '''Urinary tract infections''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::* Preferred regimen (1): [[Nitrofurantoin]] 100 mg PO q6h for 5 days
+::* Preferred regimen (2): [[Fosfomycin]] 3 g PO single dose
+::* Preferred regimen (3): [[Amoxicillin]] 875 mg to 1 g PO q12h for 5 days
+:* 5. '''Intra abdominal or wound infections''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred regimen (1): [[Penicillin]]
+::* Preferred regimen (2): [[Ampicillin]]
+::* Alternative regimen (Penicillin allergy or high-level Penicillin resistance): [[Vancomycin]]
+::* Alternative regimen (For complicated skin-skin structure and intra-abdominal infection): [[Tigecycline]] 100 mg IV single dose and 50 mg IV q12h
 ==Gallery==
@@ Line 40: / Line 110: @@
 Image: Group A streptococcus04.jpeg| Quantitative difference in hemolytic reactivity seen on BAP with group-D Streptococci (left wedge), group-B Streptococci (middle wedge), and group-A Streptococci (right wedge) bacteria.  <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
 </gallery>
 ==References==
 {{Reflist|2}}
@@ Line 47: / Line 118: @@
 [[Category:Lactobacillales]]
+[[Category:Infectious Disease Project]]
-{{disease-stub}}
-{{bacteria-stub}}
-[[de:Enterococcus faecalis]]
-[[es:Streptococcus faecalis]]
-{{WikiDoc Sources}}