From the Guidelines
For a urinary tract infection (UTI) caused by Leclercia adecarboxylata and Klebsiella pneumoniae, Augmentin (amoxicillin-clavulanate) would generally be a better choice than doxycycline. Augmentin provides better coverage against these gram-negative bacteria, particularly Klebsiella pneumoniae, which is a common urinary pathogen, as suggested by the european society of clinical microbiology and infectious diseases (escmid) guidelines 1. Some key points to consider when treating UTIs caused by these organisms include:
- Typical dosing for uncomplicated UTIs would be Augmentin 875/125 mg twice daily for 5-7 days.
- Doxycycline is not considered a first-line agent for UTIs as it achieves lower urinary concentrations and has less reliable activity against these particular organisms, with Klebsiella species often having intrinsic resistance mechanisms against tetracyclines like doxycycline.
- The definitive treatment should ideally be guided by culture and sensitivity testing, as both organisms can carry various resistance genes, as noted in the guidelines for managing infections caused by multidrug-resistant gram-negative bacilli 1.
- If treatment is urgent before sensitivity results are available, Augmentin provides broader empiric coverage for these pathogens.
- Patients should complete the full course of antibiotics even if symptoms improve quickly, and should increase fluid intake to help flush the urinary system. It's also worth noting that for patients with low-risk, non-severe infections due to gram-negative bacilli, the escmid guidelines suggest considering piperacillin-tazobactam, amoxicillin/clavulanic acid, or quinolones, under the consideration of antibiotic stewardship 1.
From the Research
Antibiotic Coverage for Leclercia adecarboxylata and Klebsiella pneumoniae in UTIs
- Doxycycline has been shown to be effective against multidrug-resistant Klebsiella pneumoniae in a urinary tract infection (UTI) case report 2.
- Leclercia adecarboxylata isolates have been found to be highly susceptible to all tested antibiotics, except one strain that was resistant to fosfomycin 3.
- There is no direct evidence on the effectiveness of doxycycline or Augmentin (amoxicillin-clavulanate) against Leclercia adecarboxylata.
- Augmentin (amoxicillin-clavulanate) was used as an empirical treatment for a UTI patient, but the treatment was switched to doxycycline after the urine culture and susceptibility panel revealed multidrug-resistant Klebsiella pneumoniae 2.
- Klebsiella pneumoniae carbapenemase-producers (KPCp) are a challenge for physicians, and new antibiotic treatments such as cefiderocol, meropenem-vaborbactam, ceftazidim-avibactam, and imipenem-relebactam may be used to manage KPCp UTIs 4.
Antibiotic Susceptibility
- Leclercia adecarboxylata isolates have shown high susceptibility to all tested antibiotics, except fosfomycin 3.
- Klebsiella pneumoniae isolates have shown resistance to various antibiotics, including carbapenems, but may be susceptible to new antibiotic treatments such as cefiderocol, meropenem-vaborbactam, ceftazidim-avibactam, and imipenem-relebactam 4.
- ESBL-producing Escherichia coli or Klebsiella pneumoniae isolates have been found to be resistant to various antibiotics, but may be susceptible to amikacin 5.