From the Guidelines
For Klebsiella infections, oral Ciprofloxacin 500 mg or 750 mg twice daily is the preferred treatment, as recommended by the British Thoracic Society guideline for bronchiectasis in adults 1. This guideline suggests that Ciprofloxacin is an effective option for treating coliforms, including Klebsiella, and can be used for 14 days. Some key points to consider when treating Klebsiella infections include:
- Antibiotic selection should be guided by susceptibility testing due to increasing resistance, particularly with extended-spectrum beta-lactamase (ESBL) producing strains.
- For ESBL-producing Klebsiella, alternative options may be considered, but the British Thoracic Society guideline recommends intravenous Ceftriaxone 2G once daily as a second-line treatment 1.
- Klebsiella pneumoniae is naturally resistant to ampicillin and amoxicillin, so these antibiotics should be avoided.
- More severe infections often require initial intravenous therapy before transitioning to oral antibiotics. It's essential to note that the Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults also discuss the treatment of Klebsiella infections, but the British Thoracic Society guideline provides more specific recommendations for oral antibiotics 1.
From the FDA Drug Label
Levofloxacin tablets are indicated for the treatment of nosocomial pneumonia due to methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, or Streptococcus pneumoniae. Levofloxacin tablets are indicated for the treatment of community-acquired pneumonia due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae (including multi-drug-resistant Streptococcus pneumoniae [MDRSP]), Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydophila pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae. Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis. Levofloxacin tablets are indicated for the treatment of uncomplicated urinary tract infections (mild to moderate) due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus.
Preferred oral antibiotics for Klebsiella include:
- Levofloxacin (PO) 2, 2, 2 Key points:
- Levofloxacin is effective against Klebsiella pneumoniae in various infections, including nosocomial pneumonia, community-acquired pneumonia, complicated urinary tract infections, and uncomplicated urinary tract infections.
- The drug label recommends using levofloxacin tablets to treat infections caused by susceptible isolates of Klebsiella pneumoniae.
From the Research
Preferred Oral Antibiotics for Klebsiella
- The preferred oral antibiotics for Klebsiella pneumoniae infections include fluoroquinolones, such as ciprofloxacin, as an alternative treatment option 3, 4.
- Fluoroquinolones have been shown to have similar clinical efficacy to β-lactams, even in critically ill patients, and can result in a shorter duration of intravenous therapy and hospital length of stay 3.
- Oral antibiotics, such as ciprofloxacin, have been found to be non-inferior to intravenous antibiotics, such as ceftriaxone, for the treatment of Klebsiella pneumoniae liver abscess 4.
- Other oral treatment options for UTIs due to ESBLs-Klebsiella pneumoniae include nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin 5.
- Fluoroquinolones, such as ciprofloxacin or levofloxacin, can be considered as a carbapenem-sparing alternative for the treatment of ESBL-producing Escherichia coli or Klebsiella pneumoniae bacteremia, if active in vitro 6.
- Trimethoprim-sulfamethoxazole has also been found to be effective in treating Klebsiella pneumoniae carbapenemase (KPC) infections, with a cure rate of 92.9% in a retrospective single-center case series 7.