What antibiotics are effective against Proteus (Proteus) infections?

From the Guidelines

Proteus species are most effectively treated with fluoroquinolones, third-generation cephalosporins, or carbapenems, as these classes have been shown to have broad-spectrum activity against Proteus mirabilis and other species 1. When considering antibiotic coverage for Proteus, it's essential to note that the choice of antibiotic should be guided by susceptibility testing, as resistance patterns can vary geographically 1.

Key Considerations

• Fluoroquinolones, such as ciprofloxacin or levofloxacin, are effective against Proteus species 1.
• Third-generation cephalosporins, including ceftriaxone or cefotaxime, are also suitable options 1.
• Carbapenems, like meropenem or imipenem, are reserved for more resistant strains 1.
• For less severe infections, trimethoprim-sulfamethoxazole may be effective 1.

Treatment Duration and Special Considerations

• Treatment duration typically ranges from 7-14 days, depending on the severity and site of infection 1.
• Complete eradication of Proteus species is crucial, especially in urinary tract infections, due to their ability to produce urease and form kidney stones 1.
• Combination therapy may be necessary for complicated infections until culture results are available 1.

From the FDA Drug Label

Tobramycin has been shown to be active against most isolates of the following bacteria both in vitro and in clinical infections: Gram-positive bacteria Staphylococcus aureus Gram-negative bacteria Citrobacter species Enterobacter species Escherichia coli Klebsiella species Morganella morganii Pseudomonas aeruginosa Proteus mirabilis Proteus vulgaris Providencia species Serratia species

Ciprofloxacin has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections Aerobic gram-positive microorganisms Enterococcus faecalis Staphylococcus saprophyticus Streptococcus pneumoniae Streptococcus pyogenes Aerobic gram-negative microorganisms Campylobacter jejuni Proteus mirabilis Citrobacter diversus Proteus vulgaris Citrobacter freundii Providencia rettgeri Enterobacter cloacae Providencia stuartii Escherichia coli Pseudomonas aeruginosa Haemophilus influenzae Salmonella typhi Haemophilus parainfluenzae Serratia marcescens Klebsiella pneumoniae Shigella boydii Moraxella catarrhalis Shigella dysenteriae Morganella morganii Shigella flexneri Neisseria gonorrhoeae Shigella sonnei

The antibiotics that cover Proteus are:

• Tobramycin 2
• Ciprofloxacin 3

From the Research

Antibiotics that Cover Proteus

• Ciprofloxacin: This antibiotic has been shown to be effective against Proteus mirabilis, although resistance has been reported in some cases 4.
• Ceftazidime: This antibiotic has also been shown to be effective against Proteus mirabilis, but resistance rates are higher than those for ciprofloxacin 4.
• Levofloxacin: As a fluoroquinolone antibiotic, levofloxacin has a broad spectrum of activity against Gram-positive and Gram-negative bacteria, including Proteus species 5, 6, 7.
• Piperacillin/tazobactam: This combination antibiotic has been shown to be effective against Pseudomonas aeruginosa, and may also be effective against Proteus species, although specific data is limited 8.
• Gentamicin: This aminoglycoside antibiotic has been shown to be effective against Pseudomonas aeruginosa, and may also be effective against Proteus species, although specific data is limited 8.

Mechanism of Action

• Ciprofloxacin and levofloxacin work by inhibiting DNA gyrase and topoisomerase IV, which are essential for bacterial DNA replication 5, 6, 7.
• Ceftazidime works by inhibiting cell wall synthesis, which is essential for bacterial growth and division 4.
• Piperacillin/tazobactam works by inhibiting cell wall synthesis, and also has activity against beta-lactamases, which can inactivate other antibiotics 8.
• Gentamicin works by binding to the bacterial 30S ribosomal subunit, which inhibits protein synthesis 8.

Resistance and Susceptibility

• Resistance to ciprofloxacin and ceftazidime has been reported in some cases, and may be influenced by factors such as biofilm formation and antibiotic exposure 4.
• Levofloxacin has been shown to be effective against a wide range of bacterial pathogens, including those that are resistant to other antibiotics 5, 6, 7.
• Piperacillin/tazobactam and gentamicin have been shown to be effective against Pseudomonas aeruginosa, but may have limited activity against other bacterial species 8.