Can Augmentin (amoxicillin-clavulanate) be used to treat an Extended-Spectrum Beta-Lactamase (ESBL) urinary tract infection (UTI) that is sensitive to it?

From the Guidelines

Augmentin (amoxicillin-clavulanate) can be considered for the treatment of an Extended-Spectrum Beta-Lactamase (ESBL) urinary tract infection (UTI) that is sensitive to it, but only in patients with low-risk, non-severe infections, and under the consideration of antibiotic stewardship. According to the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines 1, for patients with low-risk, non-severe infections due to third-generation cephalosporin-resistant Enterobacterales (3GCephRE), which include ESBL-producing organisms, the use of piperacillin-tazobactam, amoxicillin/clavulanic acid, or quinolones may be considered, with the caveat that this decision should be made with consideration of antibiotic stewardship.

The guidelines emphasize the importance of choosing an antibiotic based on the susceptibility pattern of the isolate and the severity of the infection. For severe infections or those associated with septic shock, carbapenems are recommended as the first-line treatment due to their reliability against ESBL-producing organisms. However, for non-severe, low-risk infections, amoxicillin/clavulanic acid (Augmentin) may be an option, especially when considering the principles of antibiotic stewardship to reserve broader-spectrum antibiotics for more severe cases.

It's crucial to note that while laboratory tests may indicate susceptibility to Augmentin, the clinical effectiveness can be influenced by factors such as the inoculum effect, where high concentrations of bacteria can overwhelm the beta-lactamase inhibitor component of the drug. Therefore, close monitoring of the patient's response to treatment is essential, and alternative therapies such as fosfomycin, nitrofurantoin (for uncomplicated lower UTIs), or certain aminoglycosides should be considered if there's no clinical improvement or if the infection is more severe.

Treatment duration should follow established guidelines for UTIs, typically ranging from 5-7 days for uncomplicated cystitis to 10-14 days for complicated or upper tract infections, with adjustments based on the patient's clinical response 1. The decision to use Augmentin for an ESBL UTI should be made on a case-by-case basis, taking into account the severity of the infection, the patient's overall health, and local resistance patterns, always prioritizing the principles of antibiotic stewardship to minimize the risk of further resistance development.

From the FDA Drug Label

To reduce the development of drug-resistant bacteria and maintain the effectiveness of amoxicillin and clavulanate potassium tablets USP, and other antibacterial drugs, amoxicillin and clavulanate potassium should be used only to treat infections that are proven or strongly suspected to be caused by susceptible bacteria When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. 1.5 Urinary Tract Infections – caused by beta-lactamase–producing isolates of E. coli, Klebsiella species, and Enterobacter species.

Augmentin (amoxicillin-clavulanate) can be used to treat an Extended-Spectrum Beta-Lactamase (ESBL) urinary tract infection (UTI) that is sensitive to it, as the drug label indicates that amoxicillin and clavulanate potassium is effective against beta-lactamase–producing isolates of E. coli, Klebsiella species, and Enterobacter species, which can include ESBL-producing organisms, if the infection is proven or strongly suspected to be caused by susceptible bacteria 2.

From the Research

Treatment of ESBL UTIs with Augmentin

• Augmentin (amoxicillin-clavulanate) can be used to treat Extended-Spectrum Beta-Lactamase (ESBL) urinary tract infections (UTIs) that are sensitive to it, as shown in studies 3, 4.
• A study published in 2023 found that high-dose amoxicillin with clavulanic acid was effective in treating UTIs caused by ESBL-producing Klebsiella pneumoniae, with no therapeutic failures or recurrences observed during the study period 3.
• Another study from 2015 found that oral amoxicillin-clavulanic acid treatment was effective in 84.7% of patients with ESBL-positive UTIs, with the majority of treatment failures attributed to developing resistance 4.
• The effectiveness of Augmentin in treating ESBL UTIs is dependent on the susceptibility of the causative organism, with higher minimum inhibitory concentration (MIC) levels associated with treatment failure 4.

Comparison with Other Treatments

• A study from 2021 compared the use of trimethoprim-sulfamethoxazole (TMP/SMX) with ertapenem in the treatment of UTIs caused by ESBL-producing pathogens, and found that TMP/SMX was associated with shorter hospital stays and lower costs 5.
• Another study from 2020 found that short courses (≤ 7 days) of antimicrobial therapy were effective in treating complicated ESBL-EB urinary tract infections, with no significant differences in mortality or reinfection rates compared to longer courses 6.
• A review of oral treatment options for ESBL UTIs found that pivmecillinam, fosfomycin, and nitrofurantoin were effective alternatives, with high sensitivity rates among ESBL-producing Enterobacteriaceae 7.