From the Research
For a UTI growing E. coli and Proteus, a good IV antibiotic option is meropenem-vaborbactam, as it has been shown to be effective in treating complicated urinary tract infections, including those caused by carbapenem-resistant Enterobacteriales, with a noninferiority margin compared to piperacillin-tazobactam 1. This combination provides excellent coverage against both organisms, with good urinary penetration. Some key points to consider when using meropenem-vaborbactam include:
- It is a combination carbapenem/beta-lactamase inhibitor, which helps to combat antimicrobial resistance
- It has been approved to treat complicated urinary tract infections (cUTI) and acute pyelonephritis (AP) in the USA
- Vaborbactam inhibits a number of beta-lactamases, including extended-spectrum beta-lactamases (ESBL) and the Klebsiella pneumoniae carbapenemase (KPC) group
- Meropenem-vaborbactam has been studied in two Phase 3, noninferiority trials, TANGO I and TANGO II, and has been found to be noninferior to piperacillin-tazobactam and best available therapy (BAT) for overall success and microbial eradication Alternative options may include piperacillin-tazobactam 3.375g IV every 6 hours, or ciprofloxacin 400mg IV twice daily if susceptibility is confirmed, as supported by studies such as 2 and 3. Treatment duration should be 7-14 days, depending on the severity of the infection, and ideally, therapy should be guided by culture susceptibility results and narrowed when available. Once clinical improvement occurs, consider switching to oral therapy based on susceptibilities. These recommendations target both pathogens effectively while minimizing resistance development.