Is it appropriate to discharge a patient with a wound culture positive for Enterobacter cloacae, which is sensitive to Augmentin (amoxicillin-clavulanate) and Ciprofloxacin, on this antibiotic regimen?

From the Guidelines

Ciprofloxacin is the preferred treatment for Enterobacter cloacae infections, and using it alone would be appropriate for discharge therapy, with a typical regimen of 500mg orally twice daily for 7-10 days, depending on wound severity. The choice of antibiotic is guided by the sensitivity results, and in this case, ciprofloxacin has been shown to have good activity against Enterobacter species 1. Some key points to consider when treating Enterobacter cloacae infections include:

• Enterobacter species often have inducible beta-lactamases that can develop resistance during treatment with some beta-lactam antibiotics, which is why fluoroquinolones like ciprofloxacin are often favored 1.
• Augmentin (amoxicillin-clavulanate) can be used as an alternative at 875/125mg twice daily for the same duration, but ciprofloxacin is generally preferred due to its better activity against Enterobacter species 1.
• Ensure the wound receives appropriate local care including cleaning and dressing changes.
• If the infection shows signs of spreading, worsening, or not improving after 48-72 hours of antibiotic therapy, the patient should be reevaluated.
• Complete the full course of antibiotics even if symptoms improve quickly to prevent recurrence or resistance development. It's also important to note that combination therapy with augmentin and ciprofloxacin is generally not necessary, and using ciprofloxacin alone would be sufficient for treating the infection 1.

From the Research

Treatment of Enterobacter cloacae Infection

• Enterobacter cloacae is a type of bacteria that can cause infections, including wound infections 2, 3.
• The treatment of Enterobacter cloacae infections typically involves the use of antibiotics, such as amoxicillin/clavulanate (Augmentin) and ciprofloxacin 3, 4.
• Amoxicillin/clavulanate is a broad-spectrum antibiotic that has been shown to be effective against a wide range of bacteria, including Enterobacter cloacae 2, 5.
• Ciprofloxacin is a fluoroquinolone antibiotic that is also effective against Enterobacter cloacae 3, 4.

Antibiotic Sensitivity and Resistance

• The sensitivity of Enterobacter cloacae to antibiotics can vary, and some strains may be resistant to certain antibiotics 6, 4.
• The use of amoxicillin/clavulanate and ciprofloxacin in combination may be effective against Enterobacter cloacae infections, especially in cases where the bacteria are resistant to other antibiotics 3, 4.
• However, the emergence of antibiotic-resistant strains of Enterobacter cloacae is a concern, and the use of antibiotics should be guided by susceptibility testing and clinical judgment 6, 5.

Clinical Considerations

• The treatment of Enterobacter cloacae infections should be guided by clinical experience and susceptibility testing 2, 3.
• The use of amoxicillin/clavulanate and ciprofloxacin in combination may be considered for the treatment of Enterobacter cloacae infections, especially in cases where the bacteria are sensitive to these antibiotics 3, 4.
• However, the potential for adverse effects and the development of antibiotic resistance should be carefully considered when selecting antibiotic therapy 6, 5.