From the FDA Drug Label
Levofloxacin tablets are indicated in adult patients for the treatment of complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis [see Clinical Studies (14.7)]. Levofloxacin tablets are indicated in adult patients for the treatment of complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa [see Clinical Studies (14.8)].
The recommended oral treatment for Klebsiella pneumonia in patients with Pulmonary Tuberculosis (PTB) is levofloxacin (PO), as it is indicated for the treatment of complicated urinary tract infections due to Klebsiella pneumoniae. However, it is essential to note that the drug label does not specifically address the treatment of Klebsiella pneumonia in PTB patients.
- The treatment should be guided by culture and susceptibility testing to ensure the effectiveness of the antibiotic.
- Levofloxacin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. 1
From the Research
For patients with Klebsiella pneumonia and pulmonary tuberculosis (PTB), the recommended oral treatment typically includes fluoroquinolones such as ciprofloxacin (500-750 mg twice daily) or levofloxacin (750 mg once daily) for 10-14 days, depending on severity. When considering the treatment of Klebsiella pneumonia in patients with PTB, it's essential to prioritize the most recent and highest quality evidence to guide clinical decision-making. The most recent study 2 from 2021, although focused on intravenous cefazolin versus ceftriaxone for Klebsiella pneumoniae bacteraemia, highlights the importance of considering alternative treatments to reduce antibiotic resistance. However, for oral treatment, fluoroquinolones remain a preferred option due to their efficacy against Klebsiella species, as supported by earlier studies 3, 4. It's also crucial to consider potential drug interactions with the patient's tuberculosis medications, particularly rifampin, which can reduce the effectiveness of certain antibiotics through enzyme induction, as noted in the context of tuberculosis treatment 5. Antibiotic selection should ultimately be guided by culture and sensitivity results, as Klebsiella strains increasingly show resistance to multiple antibiotics. Patients should complete the full course of antibiotics even if symptoms improve earlier. Adequate hydration and respiratory support may be needed as adjunctive measures. Treatment should be monitored closely with follow-up cultures to ensure eradication of the infection, especially given the compromised respiratory status from underlying tuberculosis. Some key points to consider in the management of these patients include:
- The use of fluoroquinolones as a first-line oral treatment option
- Consideration of drug interactions with anti-tuberculosis medications
- The importance of culture and sensitivity testing to guide antibiotic selection
- Completion of the full antibiotic course despite early symptom improvement
- Need for close monitoring and follow-up to ensure infection eradication.