From the Guidelines
For treating Extended-Spectrum Beta-Lactamase (ESBL) urinary tract infections, intravenous fosfomycin is a recommended treatment option, as it has shown no significant differences in clinical or microbiological cure compared to meropenem or piperacillin-tazobactam in patients with complicated urinary tract infections, including those with ESBL-producing Enterobacterales 1.
Treatment Options
- Intravenous fosfomycin can be considered as a carbapenem-sparing alternative for the treatment of complicated urinary tract infections caused by ESBL-producing Enterobacterales, with a treatment duration of 7-14 days depending on the severity of the infection 1.
- Carbapenems, such as meropenem or ertapenem, are also effective treatment options for ESBL urinary tract infections, but their use should be reserved for more severe cases or when other treatment options are not suitable 1.
- Aminoglycosides, such as amikacin, can be considered as an alternative treatment option, but their use is limited by the risk of nephrotoxicity, especially with prolonged treatment durations 1.
Important Considerations
- Treatment should always be guided by susceptibility testing, as ESBL-producing bacteria are resistant to most penicillins and cephalosporins 1.
- Patients should complete the full course of antibiotics, even if symptoms improve, and follow up to ensure infection clearance, as ESBL infections can recur and potentially lead to more serious conditions like sepsis if inadequately treated 1.
- The treatment duration should be closely related to the treatment of the underlying abnormality, and a shorter treatment duration may be considered in cases where short-course treatment is desirable due to relative contraindications to the antibiotic administered 1.
From the FDA Drug Label
5 grams (ceftazidime 2 grams and avibactam 0.5 grams) intravenously every 8 hours or the best available intravenous therapy (BAT) for 5 to 21 days of treatment. Among Gram-negative uropathogens from both arms of Trial 2, genotypic testing identified certain ESBL groups (e.g., TEM-1, SHV-12, CTX-M-15, CTX-M-27, KPC-2, KPC-3, OXA-48) and AmpC beta-lactamases expected to be inhibited by avibactam in isolates from 273/281 (97.2%) patients in the mMITT population.
The treatment for Extended-Spectrum Beta-Lactamase (ESBL) urinary tract infection (UTI) is avibactam (in combination with ceftazidime) 5 grams (ceftazidime 2 grams and avibactam 0.5 grams) intravenously every 8 hours for 5 to 21 days of treatment 2.
- Key points:
- Avibactam inhibits certain ESBL groups and AmpC beta-lactamases.
- Clinical and microbiological cure rates were similar to the overall results in the subset of patients with ESBL-producing uropathogens.
- Main findings:
- The clinical and microbiological response rates at the follow-up visit in the mMITT population were 70.1% and 71.5%, respectively, for avibactam-treated patients.
From the Research
Treatment Options for ESBL UTIs
The treatment options for Extended-Spectrum Beta-Lactamase (ESBL) urinary tract infections (UTIs) include:
- Oral options such as nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin for ESBL-E coli 3, 4
- Oral options such as pivmecillinam, fosfomycin, finafloxacin, and sitafloxacin for ESBL-Klebsiella pneumoniae 3
- Parenteral treatment options such as piperacillin-tazobactam, carbapenems, ceftazidime-avibactam, ceftolozane-tazobactam, and aminoglycosides for UTIs due to ESBL-producing Enterobacteriales 3, 5
- Alternative options such as trimethoprim-sulfamethoxazole (TMP/SMX) as a step-down therapy for shorter hospitalization and lower costs 6
- Ertapenem, a carbapenem, has been shown to be effective and safe in treating complicated UTIs caused by ESBL-producing bacteria in children 7
Considerations for Treatment
When selecting a treatment option, it is essential to consider the local susceptibility patterns and the specific type of ESBL-producing organism causing the UTI 3, 5. Additionally, the use of fluoroquinolones for empiric treatment of UTIs should be restricted due to increased rates of resistance 5.
Antibiotic Resistance
The emergence of multidrug-resistant ESBL-producing Enterobacteriaceae restricts significantly the therapeutic options, highlighting the need for judicious use of antibiotics and the development of new antimicrobial agents 3, 4.