Can a 79-year-old female with congestive heart failure (CHF) and a pacemaker, who has a urinary tract infection (UTI) with Proteus mirabilis, be treated with ciprofloxacin (Cipro)/levofloxacin (Levaquin) or ceftriaxone (Rocephin)?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: May 10, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

From the Guidelines

For a 79-year-old female with CHF and a pacemaker who has a UTI caused by Proteus mirabilis, I would recommend avoiding fluoroquinolones (Cipro/Levaquin) and using ceftriaxone (Rocephin) instead. Ceftriaxone 1-2g IV once daily for 7-14 days (depending on severity) would be appropriate. Fluoroquinolones should be avoided in this patient due to the increased risk of QT prolongation and potential cardiac arrhythmias, especially concerning in someone with pre-existing cardiac conditions and a pacemaker 1. Additionally, fluoroquinolones carry a risk of tendon rupture in elderly patients. Proteus mirabilis is typically susceptible to third-generation cephalosporins like ceftriaxone, making it an effective choice. Once culture and sensitivity results are available, therapy can be narrowed if appropriate. If IV therapy is not feasible, oral options like trimethoprim-sulfamethoxazole or amoxicillin-clavulanate could be considered based on susceptibility testing. Ensure adequate hydration and monitor renal function during treatment. It is also important to consider the patient's comorbidities and potential interactions with other medications when selecting an antibiotic regimen, as recommended in the management of urinary tract infection in older individuals who are frail and have multiple medical conditions 1. The choice of antibiotic should be guided by local resistance patterns and susceptibility testing, as outlined in the international clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women 1.

From the FDA Drug Label

  1. 9 Complicated Urinary Tract Infections: 5 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis URINARY TRACT INFECTIONS (complicated and uncomplicated) Caused by Escherichia coli, Proteus mirabilis, Proteus vulgaris, Morganella morganii or Klebsiella pneumoniae
  • Levofloxacin can be used to treat complicated urinary tract infections caused by Proteus mirabilis 2.
  • Ceftriaxone can be used to treat urinary tract infections (complicated and uncomplicated) caused by Proteus mirabilis 3.
  • Rocephin (Ceftriaxone) is an alternative option for treating urinary tract infections caused by Proteus mirabilis.

From the Research

Antibiotic Treatment Options for Proteus mirabilis UTI

  • The patient has a urinary tract infection (UTI) caused by Proteus mirabilis, and the treatment options are being considered.
  • According to the study 4, ciprofloxacin susceptibility rates for Proteus mirabilis were 21%, indicating potential resistance to this antibiotic.
  • The study 5 found that Proteus mirabilis strains producing extended-spectrum CTX-M-2 type beta-lactamase were resistant to cefotaxime, ceftriaxone, and aztreonam, but susceptible to ceftazidime.
  • The study 6 reported that Proteus mirabilis strains were susceptible to levofloxacin, especially in female patients, and sulfamethoxazole, especially in male patients.
  • Considering the patient's condition, including congestive heart failure (CHF) and a pacemaker, it is essential to choose an effective antibiotic treatment option.
  • Based on the available evidence, ciprofloxacin or levofloxacin may not be the best options due to potential resistance 4.
  • Rocephin (ceftriaxone) may not be effective against Proteus mirabilis producing extended-spectrum beta-lactamases 5.
  • Alternative treatment options, such as ceftazidime or other antibiotics effective against Proteus mirabilis, should be considered 5, 6.

Considerations for Antibiotic Resistance

  • The studies 4, 5 highlight the importance of considering antibiotic resistance patterns when selecting treatment options for Proteus mirabilis UTIs.
  • The patient's medical history, including CHF and a pacemaker, may increase the risk of complications from antibiotic-resistant infections.
  • It is crucial to choose an antibiotic treatment option that is effective against Proteus mirabilis and minimizes the risk of resistance development.
  • Regular monitoring of antibiotic susceptibility patterns and adjustment of treatment options as needed are essential to ensure effective treatment and prevent the spread of antibiotic-resistant strains 4, 6.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Related Questions

What antibiotics are effective against Proteus vulgaris?
What antibiotic covers cellulitis and Proteus mirabilis in a patient with a penicillin (Penicillin) allergy?
What are the implications of a Proteus (bacterial) infection in the urine?
What antibiotics are effective against Proteus (Proteus) infections?
Can cefdinir be used for UTI (Urinary Tract Infection)?
A 53-year-old female presents with fatigue, fever, body aches, chills, shortness of breath on exertion, loose stools, and chest tightness, despite being on nitrofurantoin (antibiotic) for an asymptomatic Urinary Tract Infection (UTI), with lab results showing leukocytes and protein in urine, and a chest X-ray indicating central interstitial thickening and mild bibasilar curly B-lines?
What is the relationship between Tirzepatide (a dual glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist) and surgical outcomes?
What is the diagnosis and management for a patient with symptoms of fever, shortness of breath, chest tightness, and abnormal chest X-ray findings, suggestive of nitrofurantoin (Furadantin)-induced pulmonary toxicity, presenting with hypotension?
Can Loperamide (Loperamide) be given to children?
What is the maximum dose range for Modafinil (Provigil)?
Does inadequate illumination cause eye strain?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question