What antibiotic (abx) covers Klebsiella?

Antibiotics for Klebsiella Infections

For Klebsiella infections, carbapenems (meropenem, imipenem, ertapenem) are the most effective first-line antibiotics, particularly for serious infections or when extended-spectrum beta-lactamase (ESBL) production is suspected. 1

First-line Options for Klebsiella

For Non-resistant Klebsiella:

• Third/fourth-generation cephalosporins:
  • Ceftriaxone
  • Ceftazidime
  • Cefepime
• Carbapenems:
  • Meropenem (1g IV every 8 hours)
  • Imipenem/cilastatin (1g IV every 8 hours)
  • Ertapenem (1g IV daily)
• Beta-lactam/beta-lactamase inhibitor combinations:
  • Piperacillin-tazobactam (4.5g IV every 6-8 hours)

For ESBL-producing Klebsiella:

• Carbapenems remain the treatment of choice 1, 2
• Ceftazidime-avibactam (2.5g IV every 8 hours) 3, 4

For Carbapenem-resistant Klebsiella (CRK):

• Ceftazidime-avibactam (2.5g IV every 8 hours) 1, 3, 4
• Meropenem-vaborbactam (4g IV every 8 hours) 2, 4
• Imipenem-cilastatin-relebactam (1.25g IV every 6 hours) 2, 4
• Combination therapy may be necessary:
  • Colistin plus meropenem 5
  • Colistin plus amikacin (showed 70% synergy in biofilm-associated infections) 5

Treatment Considerations

Severity-based Approach:

1. Uncomplicated infections (e.g., simple UTI):

   • Fluoroquinolones (if local resistance <20%)
   • Third-generation cephalosporins

2. Complicated infections (e.g., pyelonephritis, intra-abdominal):

   • Carbapenems
   • Piperacillin-tazobactam
   • Third/fourth-generation cephalosporins (if susceptible)

3. Severe/life-threatening infections (e.g., sepsis, pneumonia):

   • Carbapenems as first choice
   • Consider combination therapy for carbapenem-resistant strains 1

Special Situations:

• Intra-abdominal infections: Meropenem (1g every 8 hours) or combination therapy with piperacillin-tazobactam plus tigecycline 1
• Skin/soft tissue infections: Carbapenems or ceftazidime-avibactam for resistant strains 6
• Bacteremia: Carbapenems for ESBL-producers; duration 7-14 days 1, 2

Important Considerations

• Local resistance patterns should guide empiric therapy choices
• De-escalate therapy once susceptibility results are available 1
• Duration of therapy typically ranges from 7-14 days depending on infection site and severity 2
• Combination therapy may be beneficial for critically ill patients with carbapenem-resistant Klebsiella infections 1, 5

Pitfalls to Avoid

• Avoid fluoroquinolones for empiric therapy in areas with high resistance rates (>20%) 2
• Don't rely on cephalosporins alone for ESBL-producing strains even if they appear susceptible in vitro 1
• Don't delay appropriate therapy in critically ill patients with suspected resistant Klebsiella - mortality increases significantly with inappropriate initial therapy 1
• Don't use monotherapy with colistin or tigecycline for severe infections; combination therapy shows better outcomes 1, 5

Remember that resistance patterns vary geographically, and treatment should be guided by local antibiograms and patient-specific factors including infection site, severity, and previous antibiotic exposure.