From the Guidelines
The recommended treatment for Enterococcus urinary tract infections (UTIs) is a single dose of fosfomycin 3 g PO or nitrofurantoin 100 mg PO every 6 h, while for Klebsiella UTIs, the treatment should be guided by susceptibility testing, considering options such as fluoroquinolones or carbapenems. For Enterococcus UTIs, the treatment options include:
- A single dose of fosfomycin 3 g PO 1
- Nitrofurantoin 100 mg PO every 6 h 1
- High dose ampicillin (18-30 g IV daily in divided doses) or amoxicillin 500 mg IV or PO every 8 h daily 1 For Klebsiella UTIs, the treatment should be guided by susceptibility testing, considering options such as:
- Fluoroquinolones like ciprofloxacin or levofloxacin
- Trimethoprim-sulfamethoxazole
- Carbapenems such as meropenem for more resistant infections It is essential to note that antibiotic selection should ultimately be guided by susceptibility testing, as resistance patterns vary geographically 1. Patients should complete the full course of antibiotics even if symptoms improve, drink plenty of fluids, and seek medical attention if symptoms worsen or do not improve within 48-72 hours of starting treatment. The treatment duration should be extended to 10-14 days for complicated infections or pyelonephritis. In cases where patients are allergic to penicillins, fosfomycin (3g single dose) can be an effective alternative for Enterococcus UTIs 1.
From the FDA Drug Label
For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis and Proteus vulgaris Cefepime Injection is indicated for uncomplicated and complicated urinary tract infections (including pyelonephritis) caused by Escherichia coli or Klebsiella pneumoniae, when the infection is severe, or caused by Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis, when the infection is mild to moderate, including cases associated with concurrent bacteremia with these microorganisms.
The recommended treatment for Klebsiella urinary tract infections (UTIs) is:
- Cefepime (IV): 0.5-1 g IV every 12 hours for 7-10 days for mild to moderate infections, or 2 g IV every 12 hours for 10 days for severe infections 2
- Trimethoprim-sulfamethoxazole (PO): may be used to treat urinary tract infections due to susceptible strains of Klebsiella species 3
However, Enterococcus UTIs are not directly addressed in the provided drug labels. The FDA drug label does not answer the question for Enterococcus.
From the Research
Treatment Options for Klebsiella and Enterococcus UTIs
- The recommended treatment for Klebsiella and Enterococcus urinary tract infections (UTIs) is not explicitly stated in the provided studies, but fluoroquinolones, such as ciprofloxacin, have been shown to be effective against a range of uropathogens, including Klebsiella and Enterococcus 4, 5, 6.
- Ciprofloxacin has a potent bactericidal effect against most uropathogens and has been used to treat complicated UTIs, including those caused by trimethoprim/sulfamethoxazole-resistant bacteria 6.
- Extended-release ciprofloxacin has been shown to be at least as effective as the immediate-release formulation in treating UTIs, with the added convenience of once-daily dosing 4, 5.
- First-generation oral cephalosporins, such as cephalexin, may also be considered as a fluoroquinolone-sparing alternative for the treatment of UTIs caused by non-extended-spectrum beta-lactamase-producing Enterobacteriaceae 7.
- The choice of treatment should be guided by antimicrobial susceptibility testing and local resistance patterns, as well as considerations of patient compliance and potential side effects 4, 5, 7.
Considerations for Treatment
- The increasing prevalence of antimicrobial resistance among uropathogens, including Klebsiella and Enterococcus, highlights the need for careful selection of treatment options and consideration of alternative therapies 4, 5, 8.
- Patient compliance with treatment is an important factor in ensuring successful outcomes and reducing the risk of treatment failure and the spread of antibiotic resistance 4, 5.
- The use of antibiotics with favorable pharmacokinetic/pharmacodynamic profiles and convenient dosing schedules can help to improve patient compliance and reduce the risk of treatment failure 4, 5.