From the Guidelines
For a urinary tract infection (UTI) caused by Proteus species resistant to Levaquin (levofloxacin), the most appropriate antibiotic option is trimethoprim-sulfamethoxazole (Bactrim DS, 1 tablet twice daily for 7-14 days) as recommended by the European Association of Urology guidelines on urological infections 1. When considering treatment for complicated UTIs, such as those caused by Proteus species, it's crucial to take into account the severity of the illness, local resistance patterns, and specific host factors like allergies.
- The European Association of Urology guidelines emphasize the importance of appropriate management of the urological abnormality or underlying complicating factor, along with optimal antimicrobial therapy 1.
- Given that Proteus species are among the common pathogens in complicated UTIs, and considering the potential for antimicrobial resistance, urine culture and susceptibility testing are essential to guide the choice of antibiotic 1.
- The recommended treatment duration is generally 7 to 14 days, depending on the severity of the illness and the presence of underlying abnormalities, with the option to shorten the course if the patient is hemodynamically stable and afebrile for at least 48 hours 1.
- Other antibiotic options like nitrofurantoin or cephalexin may be considered based on susceptibility testing results, but trimethoprim-sulfamethoxazole is often a preferred choice due to its efficacy against Proteus species.
- In cases where oral antibiotics are not suitable, intravenous options such as ceftriaxone or ertapenem may be necessary, highlighting the need for careful selection of antibiotics based on the severity of the infection and patient factors 1.
From the Research
Antibiotic Options for Proteus UTI Resistant to Levaquin
- The study 2 found that carbapenem use remains the only available treatment option for MDR-PM isolates.
- Meropenem, a broad-spectrum antibacterial agent of the carbapenem family, has been shown to be effective against Gram-positive and Gram-negative pathogens, including extended-spectrum beta-lactamase (ESBL)- and AmpC-producing Enterobacteriaceae 3.
- Ertapenem, another carbapenem antibiotic, has also demonstrated potent bactericidal activity against Proteus mirabilis, including ESBL-producing strains 4.
- A study on antibiotic sensitivity of Proteus mirabilis urinary tract infection in patients with urinary calculi found that female patients responded best to levofloxacin, while male patients responded best to sulfamethoxazole 5.
- However, it is essential to note that the effectiveness of these antibiotics may vary depending on the specific strain of Proteus mirabilis and the patient's individual characteristics.
Considerations for Treatment
- The choice of antibiotic should be guided by susceptibility testing and clinical experience 5.
- Combination therapy with a beta-lactam and an aminoglycoside or fluoroquinolone may be considered for severe infections 6.
- Regional studies should be conducted frequently to monitor antibiotic sensitivity changes by sex, season, and year 5.