From the Guidelines
For ESBL (Extended-Spectrum Beta-Lactamase) producing organisms, ceftazidime/avibactam plus aztreonam is the recommended first-line treatment, as stated in the most recent guideline 1. This recommendation is based on the latest evidence from 2022, which suggests that this combination is effective against metallo-β-lactamase (MBL)-producing carbapenem-resistant Enterobacterales (CRE) 1. The use of ceftazidime/avibactam plus aztreonam has been shown to have a strong recommendation with moderate certainty of evidence, and it is considered a preferred option for the treatment of infections caused by MBL-producing CRE 1. Some key points to consider when treating ESBL-producing organisms include:
- The importance of susceptibility testing to guide antibiotic selection, as ESBL producers often carry resistance to multiple antibiotic classes 1
- The potential use of alternative antibiotics, such as cefiderocol, in certain cases 1
- The need for careful consideration of the patient's clinical condition, the severity of the infection, and the local resistance epidemiology when selecting an antibiotic regimen 1
- The importance of antimicrobial stewardship to preserve the effectiveness of available antibiotics and prevent the emergence of resistance 1. It is essential to note that the treatment of ESBL-producing organisms requires a tailored approach, and the choice of antibiotic should be based on the individual patient's needs and the specific characteristics of the infecting organism 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Recommended Coverage for ESBL
The recommended coverage for ESBL-producing bacteria varies depending on the severity of the infection and the patient's condition.
- For serious ESBL infections, carbapenems such as meropenem and imipenem are usually regarded as the antibiotics of choice 2.
- In patients with less severe presentations, carbapenem-sparing alternatives such as cephamycins, fluoroquinolones, and β-lactam/β-lactam inhibitor combinations (e.g., piperacillin/tazobactam) may be considered 2, 3.
- Ceftazidime-avibactam and ceftolozane-tazobactam are also considered as carbapenem-sparing agents for the treatment of serious ESBL infections 3, 4.
- For urinary tract infections (UTIs) caused by ESBL-producing Enterobacteriales, treatment options include nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, and fluoroquinolones, as well as parenteral options such as piperacillin-tazobactam, carbapenems, and ceftazidime-avibactam 5.
Specific Treatment Options
- For ESBL-E coli, treatment options include nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin 5.
- For ESBL-Klebsiella pneumoniae, treatment options include pivmecillinam, fosfomycin, finafloxacin, and sitafloxacin 5.
- For carbapenem-resistant Enterobacteriales (CRE), treatment options include ceftazidime-avibactam, meropenem/vaborbactam, imipenem/cilastatin-relebactam, and cefiderocol 5.