Optimizing Therapy for Vancomycin-resistant Enterococcal Bacteremia in Children

Pranita D. Tamma; Alice J. Hsu


Curr Opin Infect Dis. 2014;27(6):517-527. 

In This Article

Combination Therapy

The use of combination therapy does not appear to have a role in the routine treatment of VRE bacteremia, but limited existing data suggest it may improve outcomes in the treatment of VRE endocarditis.[166] Although a number of combinations of agents have been used in the clinical literature with variable success,[21,167–174] no comparative studies have been conducted to determine the most potent combination. Because of the long-standing experience with ampicillin against enterococci, the addition of high-dose ampicillin is one of the most commonly used second agents, particularly in combination with daptomycin or quinupristin-dalfopristin. Combination therapy with high-dose ampicillin has demonstrated in vitro and clinical efficacy in the treatment of recalcitrant VRE infections, even in settings in which the ampicillin MIC is upwards of 64 μg/ml.[3,168,175–178]