What is a good antibiotic for Klebsiella (Klebsiella pneumoniae) urinary tract infection (UTI)?

From the Guidelines

For Klebsiella urinary tract infections (UTIs), an intravenous third-generation cephalosporin as empirical treatment is recommended, according to the European Association of Urology guidelines 1. This recommendation is based on the most recent and highest quality study available. The guidelines suggest using a combination of antibiotics, such as amoxicillin plus an aminoglycoside or a second-generation cephalosporin plus an aminoglycoside, for complicated UTIs. However, for empirical treatment of complicated UTI with systemic symptoms, an intravenous third-generation cephalosporin is recommended. It is essential to note that ciprofloxacin should only be used if the local resistance rate is <10% and the patient does not require hospitalization. Additionally, any urological abnormality and/or underlying complicating factors should be managed. Other studies, such as those published in the Journal of Microbiology, Immunology and Infection 1, provide recommendations for the treatment of infections due to multidrug-resistant organisms, but these are not directly applicable to the treatment of Klebsiella UTIs. Therefore, the most appropriate treatment for Klebsiella UTIs should be guided by the European Association of Urology guidelines and local resistance patterns. Some key points to consider when treating Klebsiella UTIs include:

• Using an intravenous third-generation cephalosporin as empirical treatment for complicated UTIs with systemic symptoms
• Managing any urological abnormality and/or underlying complicating factors
• Adjusting empiric therapy based on culture results and susceptibility testing
• Completing the full course of antibiotics and maintaining adequate hydration for successful treatment.

From the FDA Drug Label

Mild to Moderate Uncomplicated or Complicated Urinary Tract Infections, including pyelonephritis, due to E. coli, K. pneumoniae, or P. mirabilis† 0. 5 to 1 gIV/IM¶ Every 12 hours 7 to 10 Severe Uncomplicated or Complicated Urinary Tract Infections, including pyelonephritis, due to E. coli or K. pneumoniae† 2 g IV Every 12 hours 10

Cefepime is a good antibiotic option for treating Klebsiella UTI, as it is effective against K. pneumoniae, which is a type of Klebsiella. The recommended dosage for uncomplicated or complicated UTIs due to K. pneumoniae is 0.5 to 1 g IV/IM every 12 hours for 7 to 10 days for mild to moderate cases, and 2 g IV every 12 hours for 10 days for severe cases 2.

From the Research

Treatment Options for Klebsiella UTI

• The recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females is a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam 3.
• For UTIs due to ESBLs- Klebsiella pneumoniae, treatment oral options include pivmecillinam, fosfomycin, finafloxacin, and sitafloxacin 3.
• Parenteral treatment options for UTIs due to ESBLs-producing Enterobacteriales include piperacillin-tazobactam, carbapenems, ceftazidime-avibactam, ceftolozane-tazobactam, and aminoglycosides including plazomicin 3.
• A study found that a 69-year-old woman with a multidrug-resistant Klebsiella UTI was sensitive to tigecycline and cefepime, and was treated with a 14-day course of amikacin, which resulted in resolution of her symptoms 4.
• Another study found that Klebsiella pneumoniae isolates were most sensitive to imipenem (97.7%), followed by cefroperazone.sulbactam (95.8%), and piperacillin.tazobactam (95.7%) 5.
• A narrative review found that cefiderocol, meropenem-vaborbactam, ceftazidim-avibactam, and imipenem-relebactam represent a major step forward in the treatment of KPCp UTIs, but no guidelines are currently available for choosing the most appropriate treatment 6.

Antibiotic Resistance

• High rates of resistance for trimethoprim-sulfamethoxazole and ciprofloxacin preclude their use as empiric treatment of UTIs in several communities, particularly if patients who were recently exposed to them or in patients who are at risk of infections with extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriales 3.
• A study found that Klebsiella pneumoniae isolates had low sensitivity to amoxicillin (0.1%), doxycycline (11.5%), and nitrofurantoin (15.5%) 5.
• The misuse of antibiotics by doctors and self-medication has exacerbated the menace of microbial resistance 5.

Treatment Strategies

• Susceptibility testing is an important tool for optimizing antibiotic therapy, however, automated systems may overestimate the susceptibility profile for a MDR GNB 4.
• Treatment strategies evaluated to treat MDR GNB include combination therapy with a carbepenem and synergy using polymyxin 4.
• The use of new antibiotic treatments, such as cefiderocol, meropenem-vaborbactam, ceftazidim-avibactam, and imipenem-relebactam, may be effective in treating KPCp UTIs, but more research is needed to determine the best treatment strategy 6.