From the Guidelines
For treating a Klebsiella urinary tract infection (UTI), oral fluoroquinolones like ciprofloxacin (500 mg twice daily for 7 days) or levofloxacin (750 mg once daily for 5 days) are often effective first-line options, as recommended by the most recent guidelines 1. When considering treatment options for a Klebsiella UTI, it's essential to prioritize the patient's morbidity, mortality, and quality of life. The choice of antibiotic should be guided by susceptibility testing, as Klebsiella species increasingly show resistance to many antibiotics.
- The most recent guidelines from 2024 1 suggest that fluoroquinolones are a clear recommendation for adult pyelonephritis, with a duration of 5 to 7 days.
- Trimethoprim-sulfamethoxazole (TMP-SMX) may also be used if the organism is susceptible, with a recommended duration of 3 days for adult cystitis 1.
- For patients who cannot take these medications, oral third-generation cephalosporins such as cefpodoxime or cefdinir are alternatives, although the evidence for their use is not as strong 1.
- It's crucial to note that Klebsiella pneumoniae is naturally resistant to ampicillin and amoxicillin, so these antibiotics should be avoided unless combined with a beta-lactamase inhibitor like clavulanic acid.
- Patients should complete the full course of antibiotics even if symptoms improve, drink plenty of fluids, and seek medical attention if symptoms worsen or don't improve within 48-72 hours. The treatment choice should be based on the most recent and highest-quality evidence, which in this case is the 2024 guidelines from the JAMA network open 1.
From the FDA Drug Label
Ciprofloxacin is eliminated primarily by renal excretion; however, the drug is also metabolized and partially cleared through the biliary system of the liver and through the intestine. Dosing and initial route of therapy (i.e., I.V. or oral) for complicated urinary tract infection or pyelonephritis should be determined by the severity of the infection.
The recommended oral antibiotic for a Urinary Tract Infection (UTI) caused by Klebsiella is Ciprofloxacin (PO).
- The dose is 250-500 mg q 12 h for patients with normal renal function, but may need to be adjusted based on the severity of the infection and renal function. 2
From the Research
Recommended Oral Antibiotics for UTI caused by Klebsiella
- The recommended oral antibiotics for UTI caused by Klebsiella include:
- These antibiotics have shown effectiveness against ESBL-producing Klebsiella pneumoniae, which is a common cause of UTIs 3, 4.
- The susceptibility rates of Klebsiella species to these antibiotics vary, with pivmecillinam being the most effective (83%) 4, followed by fosfomycin (62-76.1%) 5, 4, 6, and nitrofurantoin (42-68.4%) 5, 4, 6.
- It is essential to note that the susceptibility rates may vary depending on the region and local resistance patterns, and therefore, it is crucial to determine the local antimicrobial susceptibility patterns to guide treatment decisions 6.