What is the appropriate antibiotic treatment for Klebsiella (a type of bacteria) urinary tract infection (UTI)?

From the Guidelines

For patients with Klebsiella urinary tract infections, a carbapenem such as meropenem or ertapenem is recommended as targeted therapy, especially for severe infections or resistant strains, as suggested by the European Society of Clinical Microbiology and Infectious Diseases guidelines 1. When considering treatment options, it's essential to note that Klebsiella species are increasingly developing resistance to multiple antibiotics.

• The European Society of Clinical Microbiology and Infectious Diseases guidelines recommend carbapenems, such as meropenem or ertapenem, for severe infections or resistant strains 1.
• For low-risk, non-severe infections, piperacillin-tazobactam, amoxicillin/clavulanic acid, or quinolones may be considered, taking into account antibiotic stewardship 1.
• The European Association of Urology guidelines suggest using a combination of amoxicillin plus an aminoglycoside or a second-generation cephalosporin plus an aminoglycoside for complicated UTIs, but emphasize the importance of managing any urological abnormality and/or underlying complicating factors 1.
• It's crucial to guide treatment by urine culture and sensitivity testing whenever possible, as Klebsiella species are increasingly developing resistance to multiple antibiotics, including extended-spectrum beta-lactamase (ESBL) producing strains 1.
• Treatment duration typically ranges from 7-14 days, depending on infection severity, with uncomplicated infections requiring shorter courses 1.
• Increased fluid intake helps flush bacteria from the urinary tract, and completing the full antibiotic course is essential to prevent recurrence and antibiotic resistance.

From the FDA Drug Label

CLINICAL STUDIES Complicated Urinary Tract Infection and Pyelonephritis – Efficacy in Pediatric Patients Bacteriologic Eradication of the Baseline Pathogen at 5 to 9 Days Post-Treatment Escherichia coli 156/178 (88%) 161/179 (90%)

The antibiotic treatment for Klebsiella in the urine is not directly addressed in the provided drug label, as it only mentions Escherichia coli. 2

From the Research

Antibiotic Treatment for Klebsiella in the Urine

• The treatment of Klebsiella pneumoniae infections, particularly those causing urinary tract infections (UTIs), has become challenging due to the emergence of extended-spectrum beta-lactamase (ESBL)-producing strains 3, 4.
• Studies have shown that certain antibiotics, such as imipenem and meropenem, are effective against ESBL-producing Klebsiella pneumoniae 3, 4, 5.
• Fosfomycin has been found to have good susceptibility against ESBL-producing E. coli, but its effectiveness against ESBL-producing Klebsiella pneumoniae is lower 3.
• Other antibiotics, such as cefazolin and ceftriaxone, have also been studied as potential treatment options for Klebsiella pneumoniae bacteraemia 6.
• The use of carbapenems, such as meropenem, has been shown to be effective in treating ESBL-producing Klebsiella pneumoniae bacteraemia, and flomoxef may be a viable alternative in certain cases 7.

Antibiotic Resistance Patterns

• Resistance to certain antibiotics, such as ciprofloxacin and gentamicin, is common among Klebsiella pneumoniae isolates 4, 5.
• The prevalence of ESBL-producing Klebsiella pneumoniae is high, and these strains often exhibit resistance to multiple antibiotics 4, 5.
• The misuse of antibiotics has contributed to the development of antibiotic resistance, highlighting the need for prudent antibiotic use and adherence to prevailing sensitivity profiles 5.

Treatment Options

• Imipenem and meropenem are effective treatment options for ESBL-producing Klebsiella pneumoniae infections 3, 4, 5.
• Fosfomycin may be a viable treatment option for UTIs caused by ESBL-producing E. coli, but its use against Klebsiella pneumoniae is limited 3.
• Cefazolin and ceftriaxone may be used to treat Klebsiella pneumoniae bacteraemia, although their effectiveness depends on the susceptibility of the isolate 6.
• Flomoxef may be a viable alternative to carbapenems in certain cases of ESBL-producing Klebsiella pneumoniae bacteraemia 7.