Which antibiotics (abx) cover Proteus?

From the Guidelines

Proteus species are typically susceptible to fluoroquinolones, third-generation cephalosporins, aminoglycosides, carbapenems, and piperacillin-tazobactam, and the most effective treatment should be chosen based on local resistance patterns and culture results. When considering the treatment of Proteus infections, it's essential to prioritize the most recent and highest-quality evidence to ensure the best outcomes in terms of morbidity, mortality, and quality of life.

Key Considerations

• The choice of antibiotic should cover gram-negative bacteria, including Proteus species, and should be guided by local resistance patterns and susceptibility testing whenever possible 1.
• Fluoroquinolones, such as ciprofloxacin and levofloxacin, are effective against Proteus species, but their use should be balanced with concerns about resistance and side effects 1.
• Third-generation cephalosporins, like ceftriaxone and cefotaxime, are also effective and can be used in combination with other antibiotics for severe infections 1.
• Aminoglycosides, such as gentamicin and amikacin, and carbapenems, like meropenem and imipenem, are additional options for treating Proteus infections, especially in cases of severe disease or resistance to other antibiotics 1.
• Piperacillin-tazobactam is another effective option, offering broad-spectrum coverage, including against Proteus species 1.

Treatment Approach

• For uncomplicated urinary tract infections caused by Proteus, trimethoprim-sulfamethoxazole or nitrofurantoin may be considered, though resistance to these agents is increasing, and local epidemiology should guide the choice 1.
• Empiric therapy should be adjusted based on culture results, and the duration of treatment depends on the infection site and severity, typically ranging from 3-7 days for uncomplicated UTIs to 10-14 days for more severe infections 1.
• It's crucial to consider the production of urease by Proteus species, which can lead to struvite stone formation, making prompt and effective antibiotic treatment particularly important in urinary tract infections 1.

Evidence Summary

The most recent and highest-quality evidence supports the use of fluoroquinolones, third-generation cephalosporins, aminoglycosides, carbapenems, and piperacillin-tazobactam for the treatment of Proteus infections, with the choice of antibiotic guided by local resistance patterns, susceptibility testing, and the severity of the infection 1.

From the FDA Drug Label

Aerobic gram-negative microorganisms Proteus mirabilis Proteus vulgaris

Gram-negative bacteria Proteus mirabilis Proteus vulgaris

Gram-negative bacteria Proteus mirabilis Proteus vulgaris

The antibiotics that cover Proteus are:

• Ciprofloxacin 2
• Meropenem 3
• Ceftazidime 4

From the Research

Antibiotics that Cover Proteus

• The following antibiotics have been shown to be effective against Proteus:
  • Ceftazidime 5
  • Ciprofloxacin 5, 6
  • Meropenem 7
  • Piperacillin/tazobactam 8, 7
• It is essential to note that the susceptibility of Proteus to these antibiotics can vary depending on the specific strain and the presence of resistance mechanisms 5, 8
• The use of these antibiotics should be guided by local susceptibility patterns and the results of antimicrobial susceptibility testing 9, 8

Resistance Patterns

• Resistance to ceftazidime and ciprofloxacin has been reported in Proteus mirabilis strains 5
• The use of antibiotics can exert selection pressure, leading to the development of resistance 8
• The circulation of resistance genes in the bacterial population can also contribute to the development of resistance 8

Treatment Options

• The choice of antibiotic for the treatment of Proteus infections should be based on the results of antimicrobial susceptibility testing and local susceptibility patterns 9, 8
• Combination therapy may be necessary in cases of complex infections or in patients with underlying medical conditions 9