From the Guidelines
Augmentin (amoxicillin-clavulanate) can be used to treat ESBL-producing bacterial UTIs if the bacteria are sensitive, as suggested by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines 1. For patients with low-risk, non-severe infections due to ESBL-producing bacteria, the guidelines suggest piperacillin-tazobactam, amoxicillin/clavulanic acid, or quinolones as potential treatment options, with the consideration of antibiotic stewardship 1. Some key points to consider when using Augmentin for ESBL UTIs include:
- The clavulanic acid component in Augmentin inhibits some beta-lactamases, but may not be effective against all ESBL enzymes.
- Treatment decisions should always be guided by culture and sensitivity results.
- The clinical response should be monitored closely.
- If Augmentin is used, ensure the full prescribed course is completed even if symptoms improve quickly to prevent recurrence and further resistance development. Additionally, the European Association of Urology guidelines on urological infections suggest managing any urological abnormality and/or underlying complicating factors, and using a combination of antibiotics for complicated UTIs, but do not specifically recommend Augmentin for ESBL-producing bacteria 1. However, based on the most recent and highest quality study, the use of Augmentin for ESBL UTIs is conditionally recommended for low-risk, non-severe infections, with careful consideration of antibiotic stewardship and close monitoring of the clinical response 1.
From the FDA Drug Label
To reduce the development of drug-resistant bacteria and maintain the effectiveness of amoxicillin and clavulanate potassium tablets USP, and other antibacterial drugs, amoxicillin and clavulanate potassium should be used only to treat infections that are proven or strongly suspected to be caused by susceptible bacteria 1.5 Urinary Tract Infections – caused by beta-lactamase–producing isolates of E. coli, Klebsiella species, and Enterobacter species.
Augmentin (amoxicillin-clavulanate) can be used to treat ESBL UTIs if the bacteria are sensitive, as it is indicated for urinary tract infections caused by beta-lactamase–producing isolates of E. coli, Klebsiella species, and Enterobacter species 2.
- Key points:
- The drug label indicates the use of amoxicillin-clavulanate for UTIs caused by beta-lactamase–producing bacteria.
- ESBL-producing bacteria are a type of beta-lactamase–producing bacteria.
- The label recommends using the drug only for infections caused by susceptible bacteria.
From the Research
Treatment Options for ESBL UTIs
- Augmentin (amoxicillin-clavulanate) can be used to treat Extended-Spectrum Beta-Lactamase (ESBL) urinary tract infections (UTIs) if the bacteria are sensitive, as shown in studies 3, 4.
- The effectiveness of amoxicillin-clavulanate in treating ESBL-positive UTIs depends on the minimum inhibitory concentration (MIC) of the antibiotic, with higher MICs associated with treatment failure 3.
- Other oral treatment options for ESBL UTIs include pivmecillinam, fosfomycin, and nitrofurantoin, which have shown high sensitivity rates against ESBL-producing Enterobacteriaceae 5, 4.
Considerations for Treatment
- The choice of antibiotic should be guided by local susceptibility patterns and the results of urine culture and sensitivity testing 6, 4.
- The use of fluoroquinolones for empiric treatment of UTIs should be restricted due to increased rates of resistance 6, 4.
- Carbapenems, such as ertapenem, may be used to treat complicated UTIs caused by ESBL-producing organisms, but their use should be reserved for severe cases or when other options are not available 7.
Key Findings
- Amoxicillin-clavulanate may be a good oral antimicrobial option for treating ESBL-positive UTIs, but its effectiveness depends on the susceptibility of the causative agent 3.
- Pivmecillinam, fosfomycin, and nitrofurantoin are effective oral treatment options for ESBL UTIs, with high sensitivity rates against ESBL-producing Enterobacteriaceae 5, 4.