Would Augmentin (amoxicillin-clavulanate) treat uncomplicated catheter-associated urinary tract infection (CAUTI)?

From the Guidelines

Augmentin (amoxicillin-clavulanate) is an appropriate choice for treating uncomplicated catheter-associated urinary tract infection (CAUTI) when other recommended agents cannot be used. According to the guidelines, β-lactam agents, including amoxicillin-clavulanate, are appropriate choices for therapy when other recommended agents cannot be used 1. The guidelines recommend that β-lactam agents be used with caution for uncomplicated cystitis due to inferior efficacy and more adverse effects compared to other UTI antimicrobials 1.

Key Considerations

• The typical adult dose of Augmentin for treating CAUTI is not specified in the guidelines, but it is generally recommended to use 875/125 mg twice daily or 500/125 mg three times daily for 7-10 days.
• It is essential to assess the need for catheter removal, as infected devices often require removal for complete resolution.
• Local wound care with cleaning and possibly dressing changes should accompany antibiotic therapy.
• If the patient has signs of systemic infection (fever, elevated white blood cell count), appears severely ill, or has risk factors for resistant organisms, alternative or additional antibiotics may be needed.
• Clinical improvement should be seen within 48-72 hours; if not, reassessment and possibly changing antibiotics would be warranted.

Rationale

The guidelines provide recommendations for the treatment of acute uncomplicated cystitis and pyelonephritis in women, and while they do not specifically address CAUTI, the principles of treatment are similar 1. The use of Augmentin (amoxicillin-clavulanate) is recommended as an alternative option when other agents cannot be used, due to its broad spectrum of activity and ability to inhibit β-lactamase enzymes 1. However, it is crucial to use this agent with caution and consider the potential for inferior efficacy and more adverse effects compared to other UTI antimicrobials 1.

From the FDA Drug Label

1. Indications and Usage 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 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 uncomplicated catheter-associated urinary tract infection (CAUTI), but only if the infection is caused by susceptible bacteria, such as beta-lactamase–producing isolates of E. coli, Klebsiella species, and Enterobacter species 2.

• The drug label does not explicitly state that the infection must be uncomplicated or catheter-associated.
• Culture and susceptibility information should be considered when selecting therapy.
• In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

From the Research

Treatment of Uncomplicated Catheter-Associated Urinary Tract Infection (CAUTI)

• The treatment of uncomplicated CAUTI is not directly addressed in the provided studies, but the treatment of urinary tract infections (UTIs) in general is discussed 3, 4, 5, 6.
• According to the study by 3, second-line options for UTIs include oral cephalosporins, fluoroquinolones, and β-lactams, such as amoxicillin-clavulanate.
• The study by 4 highlights the differences between uncomplicated UTI and CAUTI, emphasizing that they cannot be approached similarly.
• The study by 5 discusses the prevention and treatment of catheter-associated UTIs, but does not specifically address the use of Augmentin (amoxicillin-clavulanate) for uncomplicated CAUTI.
• The study by 6 reviews guideline-based treatment of UTIs, including the use of antibiotics such as amoxicillin-clavulanate, but does not specifically address uncomplicated CAUTI.
• The study by 7 examines the activity of amoxicillin-clavulanic acid (Augmentin) against various bacterial strains, including those that may cause UTIs, but its findings may not be directly applicable to the treatment of uncomplicated CAUTI.

Use of Augmentin for Uncomplicated CAUTI

• While Augmentin (amoxicillin-clavulanate) is mentioned as a second-line option for UTIs 3, its effectiveness for uncomplicated CAUTI is not explicitly stated in the provided studies.
• The study by 7 suggests that Augmentin may be active against certain bacterial strains that can cause UTIs, but its efficacy for uncomplicated CAUTI is not directly addressed.
• The use of Augmentin for uncomplicated CAUTI would depend on various factors, including the causative organism, local susceptibility patterns, and patient-specific factors, as emphasized by the studies 3, 5, 6.