From the Guidelines
Treatment for multidrug-resistant (MDR) Klebsiella pneumoniae should be initiated with either ceftazidime/avibactam or meropenem/vaborbactam as the first-line option, considering the site of infection and local epidemiology.
Key Considerations
- The choice between ceftazidime/avibactam and meropenem/vaborbactam should consider the site of infection, with meropenem/vaborbactam potentially being preferred for pneumonia due to its pharmacokinetic properties, as suggested by studies such as 1.
- Local epidemiology and the emergence of resistance to ceftazidime/avibactam should also guide the selection, with meropenem/vaborbactam being an alternative in cases of ceftazidime/avibactam resistance, as noted in 1.
- Imipenem/relebactam and cefiderocol may be considered as potential alternatives based on in vitro data, although clinical evidence is limited, as discussed in 1.
Treatment Approach
- The treatment approach should prioritize the use of novel β-lactam agents due to their efficacy and safety profile compared to traditional antibiotic regimens, which have been associated with poor outcomes and toxicity, as highlighted in 1.
- The duration of treatment and the need for source control should be determined based on the severity and site of the infection, as well as clinical response, with a typical duration ranging from 7-14 days.
- It is crucial to monitor for resistance patterns and adjust treatment accordingly, considering the potential for KPC variants that may confer resistance to certain antibiotics, as mentioned in 1.
From the FDA Drug Label
AVYCAZ (ceftazidime and avibactam) is indicated for the treatment of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP) in adult and pediatric patients (at least 31 weeks gestational age) caused by the following susceptible gram-negative microorganisms: Klebsiella pneumoniae, Enterobacter cloacae, Escherichia coli, Serratia marcescens, Proteus mirabilis, Pseudomonas aeruginosa, and Haemophilus influenzae. The treatment for multidrug-resistant (MDR) Klebsiella pneumoniae pneumonia is AVYCAZ (ceftazidime and avibactam), which can be used to treat hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP) caused by susceptible gram-negative microorganisms, including Klebsiella pneumoniae. The recommended dosage of AVYCAZ is:
- 2.5 grams (ceftazidime 2 grams and avibactam 0.5 grams) administered every 8 hours by intravenous (IV) infusion over 2 hours in adult patients.
- 62.5 mg/kg to a maximum of 2.5 grams (ceftazidime 50 mg/kg and avibactam 12.5 mg/kg to a maximum dose of ceftazidime 2 grams and avibactam 0.5 grams) administered every 8 hours by intravenous infusion over 2 hours in pediatric patients aged 2 years to less than 18 years 2.
From the Research
Treatment Options for MDR Klebsiella Pneumonia
- The treatment of multidrug-resistant (MDR) Klebsiella pneumoniae infections is challenging due to the limited availability of effective antimicrobials 3.
- Current treatment options include:
- Ceftazidime/avibactam, which has shown efficacy in treating carbapenem-resistant K. pneumoniae infections 4, 5, 6.
- Colistin, which is often used in combination with other antimicrobials, such as ceftazidime/avibactam or aztreonam 4, 7.
- Tigecycline, gentamicin, and fosfomycin, which may be effective against some MDR K. pneumoniae strains 3.
- Novel antimicrobials, such as plazomicin and cefiderocol, which are being developed to combat MDR K. pneumoniae infections 3.
Combination Therapy
- Combination therapy, such as ceftazidime/avibactam plus aztreonam, may be effective in treating MDR K. pneumoniae infections 4.
- The use of combination therapy, such as meropenem plus vaborbactam or meropenem plus colistin, has been shown to improve clinical outcomes in patients with carbapenem-resistant K. pneumoniae infections 7.