Is Augmentin (amoxicillin-clavulanate) effective against Klebsiella infections?

From the Guidelines

Augmentin should not be used as a first-line treatment for Klebsiella infections due to high resistance rates, and alternative antibiotics such as carbapenems or fluoroquinolones should be considered based on susceptibility testing 1. When considering treatment for Klebsiella infections, it's essential to note that many strains have developed resistance to beta-lactam antibiotics, including Augmentin, through production of extended-spectrum beta-lactamases (ESBLs) or other resistance mechanisms 1.

• The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines recommend carbapenems, such as imipenem or meropenem, as targeted therapy for patients with bloodstream infections (BSI) and severe infections due to third-generation cephalosporin-resistant Enterobacterales (3GCephRE), which includes Klebsiella species 1.
• For patients with low-risk, non-severe infections due to 3GCephRE, the guidelines suggest piperacillin-tazobactam, amoxicillin/clavulanic acid, or quinolones, but with consideration of antibiotic stewardship and based on susceptibility testing 1.
• Laboratory culture and susceptibility testing are crucial before treating Klebsiella infections to ensure the selected antibiotic will be effective, and alternative antibiotics such as carbapenems, fluoroquinolones, or aminoglycosides may be necessary in cases of suspected or confirmed resistant Klebsiella 1.
• The most recent and highest quality study, published in 2022, provides guidance on the treatment of infections caused by multidrug-resistant Gram-negative bacilli, including Klebsiella species, and emphasizes the importance of susceptibility testing and antibiotic stewardship 1.

From the FDA Drug Label

1.4 Skin and Skin Structure Infections – caused by beta-lactamase–producing isolates of Staphylococcus aureus, Escherichia coli, and Klebsiella species. 1.5 Urinary Tract Infections – caused by beta-lactamase–producing isolates of E. coli, Klebsiella species, and Enterobacter species. Amoxicillin/clavulanic acid has been shown to be active against most isolates of the following bacteria, both in vitro and in clinical infections as described in the INDICATIONS AND USAGE section Gram-negative bacteria Enterobacter species Escherichia coli Haemophilus influenzae Klebsiella species Moraxella catarrhalis

Augmentin treats Klebsiella in certain types of infections, including:

• Skin and skin structure infections
• Urinary tract infections 2

From the Research

Augmentin Treatment for Klebsiella

• Augmentin, a combination of amoxicillin and clavulanic acid, is used to treat various bacterial infections, including those caused by Klebsiella species 3.
• However, the effectiveness of Augmentin against Klebsiella pneumoniae, a common cause of urinary tract infections, is limited due to the emergence of extended-spectrum beta-lactamase (ESBL)-producing strains 4, 5.
• A study published in 2023 found that high-dose amoxicillin with clavulanic acid can be effective in treating urinary tract infections caused by ESBL-producing Klebsiella pneumoniae 5.
• Another study published in 2013 reported low sensitivity of Klebsiella isolates to amoxicillin-clavulanate (18.2%) 6.
• The use of Augmentin to treat Klebsiella infections should be guided by culture and sensitivity testing to ensure effective treatment and minimize the risk of resistance development 4, 6.

Mechanism of Resistance

• Klebsiella species can develop resistance to beta-lactam antibiotics, including Augmentin, through the production of extended-spectrum beta-lactamases (ESBLs) 4.
• The use of high-dose amoxicillin with clavulanic acid may help to overcome this resistance, but the emergence of new resistance mechanisms is a concern 5.

Alternative Treatment Options

• Other antibiotics, such as carbapenems, fluoroquinolones, and aminoglycosides, may be effective against Klebsiella infections, but their use should be guided by culture and sensitivity testing 4, 6.
• The development of new treatments and prevention strategies, including vaccines, is needed to address the growing problem of antimicrobial resistance in Klebsiella species 7.