From the FDA Drug Label
PRIMAXIN is indicated for the treatment of urinary tract infections (complicated and uncomplicated) caused by susceptible strains of Enterococcus faecalis, Staphylococcus aureus (penicillinase-producing isolates), Enterobacter species, Escherichia coli, Klebsiella species, Morganella morganii, Proteus vulgaris, Providencia rettgeri, Pseudomonas aeruginosa.
The antibiotic therapy that can be used to treat Enterococcus faecalis and Pseudomonas UTI is imipenem-cilastatin (IV) 1.
- Key points:
- Enterococcus faecalis and Pseudomonas aeruginosa are susceptible to imipenem-cilastatin.
- Imipenem-cilastatin is indicated for the treatment of urinary tract infections (complicated and uncomplicated) caused by these bacteria.
From the Research
For a urinary tract infection (UTI) caused by both Enterococcus faecalis and Pseudomonas, I recommend combination therapy with an antipseudomonal agent such as ciprofloxacin or ceftazidime, along with an agent active against Enterococcus, such as ampicillin or daptomycin, as suggested by 2 and 3. A typical regimen would be ciprofloxacin 500mg orally twice daily or ceftazidime 1-2g IV every 8 hours, plus ampicillin 2g IV every 6 hours or daptomycin 4-6 mg/kg IV every 24 hours, for 7-14 days depending on infection severity. For complicated UTIs or pyelonephritis, the longer duration is appropriate. This combination is necessary because Enterococcus faecalis is typically resistant to cephalosporins alone, while Pseudomonas requires specific antipseudomonal coverage. If the patient has risk factors for resistant organisms, such as recent hospitalization or antibiotic use, consider adding an aminoglycoside like gentamicin. Obtaining urine culture with susceptibility testing is crucial to guide definitive therapy, as resistance patterns can vary, as noted in 4 and 5. Ensure adequate hydration during treatment and monitor renal function, especially if using aminoglycosides. Treatment should be adjusted based on clinical response and susceptibility results when available. It's also important to consider the potential for antibiotic resistance, as discussed in 3 and 5, and to choose antibiotics wisely to minimize the risk of resistance development. In addition, removal of indwelling urinary catheters should be considered, as suggested by 2, to prevent further infection. Overall, the choice of antibiotic therapy should be guided by the most recent and highest quality evidence, as well as consideration of the individual patient's risk factors and clinical presentation.