Safety and efficacy of commonly used antimicrobial agents in the treatment of enterococcal infections: a review.

INTRODUCTION: Enterococci have become the second leading cause of nosocomial infections in the U.S, which are associated with higher morbidity, mortality, length of stay, and cost due to escalating resistance to several antimicrobial agents. With limited treatment options, the adverse events associated with the increasing use of available agents must be considered. AREAS COVERED: Safety data about the most commonly used antimicrobial agents to treat enterococcal infections (ampicillin, vancomycin, linezolid, daptomycin, and tigecycline) derived from animal models, clinical trials and post-marketing surveillance are evaluated. However, most of these agents are not FDA approved and have been used for off-label indications in enterococcal infections. EXPERT OPINION: The commonly used antimicrobials to treat enterococcal infections have unique safety profiles and side effects but are generally safe and tolerated in the short-term based on data from clinical trials and post-marketing surveillance. However, serious long-term adverse events may occur, and antibiotic selection should be individualized and based on source of infection, duration, potential drug-related toxicity, and drug-drug interactions to minimize side-effects. Implementing standard precautions and infection control measures, minimizing unnecessary antibiotic exposure, and optimizing treatment and duration with removal of source of infection are essential to prevent the spread of resistance and improve outcomes.