From the FDA Drug Label
Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis
The recommended treatment for a UTI caused by Enterobacter aerogenes in a patient with multiple comorbidities and known allergies is not directly stated in the label, as Enterobacter aerogenes is not explicitly mentioned. However, Enterobacter cloacae is mentioned, which is a related species.
- Key consideration: The patient's known allergies to various substances do not appear to be relevant to the use of levofloxacin.
- Clinical decision: Based on the information provided, levofloxacin may be considered as a treatment option for the UTI, given its indication for complicated urinary tract infections due to related species. However, caution should be exercised due to the lack of direct evidence for Enterobacter aerogenes and the patient's multiple comorbidities. 1
From the Research
For a patient with a UTI caused by Enterobacter aerogenes and multiple comorbidities, I recommend fosfomycin as the first-line treatment option, given its high efficacy and stability against AmpC beta-lactamases, as demonstrated in the most recent study 2. The patient's allergies to fexofenadine, bee venom, codeine, lactose, shellfish-derived products, strawberry extract, and iodine-based contrast media do not contraindicate the use of fosfomycin. Key points to consider in the treatment of this patient include:
- Fosfomycin has been shown to have high activity against common etiologies that cause bacteremic urinary tract infections (bUTIs), including Enterobacter aerogenes, with susceptibility rates similar to or higher than those of other first-line antibiotics 2.
- The use of fosfomycin is particularly important in patients with multiple comorbidities, as it has been shown to be effective against isolates producing extended-spectrum beta-lactamases (ESBLs) and those that are resistant to other first-line treatments 2.
- Monitoring renal function is crucial in this patient, and follow-up urine cultures should be considered if symptoms persist.
- Other treatment options, such as ciprofloxacin or ertapenem, may also be effective, but fosfomycin is the preferred choice due to its high efficacy and stability against AmpC beta-lactamases, as demonstrated in the most recent study 2.