From the Research
Vancomycin is not effective against Klebsiella urinary tract infections. Klebsiella species are gram-negative bacteria, and vancomycin is only effective against gram-positive organisms because it cannot penetrate the outer membrane of gram-negative bacteria. For Klebsiella UTIs, appropriate antibiotic choices typically include:
- Fluoroquinolones (such as ciprofloxacin 500 mg twice daily for 7 days)
- Third-generation cephalosporins (like ceftriaxone 1-2 g daily)
- Carbapenems (such as meropenem 1 g every 8 hours)
- Aminoglycosides (gentamicin 5 mg/kg daily), depending on susceptibility testing 1. Treatment duration is typically 7-14 days based on infection severity. Due to increasing antibiotic resistance in Klebsiella, especially extended-spectrum beta-lactamase (ESBL) producing strains, antibiotic susceptibility testing is crucial for selecting effective therapy. Empiric therapy should be guided by local resistance patterns until culture results are available, and treatment may need adjustment based on these results. A recent study published in 2025 found that trimethoprim-sulfamethoxazole can be a cost-effective long-term solution for patients with multidrug-resistant K. pneumoniae UTIs 2. However, the most recent and highest quality study should always be prioritized when making treatment decisions. In this case, the study from 2020 provides the most comprehensive guidance on treating UTIs, including those caused by Klebsiella 1.