Synercid (quinupristin and dalfopristin) is an alternative therapy for systemic infections with VRE. It is FDA approved for treatment of life threatening infections with vancomycin resistant isolates of E. faecium. This antibiotic is appropriately suppressed from reports of other vancomycin sensitive strains of E. faecium, and all other species of Enterococcus.
Linezolid belongs to the oxazolidinone class of antibiotics. It is active against VRE. The main indication of linezolid is treatment of severe infections caused by gram-positive bacteria that are resistant to other antibiotics.
Daptomycin is the first lipopeptide released onto the market. Daptomycin has been approved for the treatment of skin and soft tissue infections; evaluation of efficacy in more serious systemic infections is ongoing. Disk diffusion testing for Daptomycin is not reliable.
Telavancin is a lipoglycopeptide under trial for MRSA and other gram-positive infections. The spectrum of activity of telavancin is similar to vancomycin, but it may be active against some VRE strains (Van B).