From the Guidelines
For the treatment of E. coli complicated UTI, the most effective approach is to use a combination of antibiotics, such as amoxicillin plus an aminoglycoside, or a second-generation cephalosporin plus an aminoglycoside, as recommended by the European Association of Urology guidelines 1.
Key Considerations
- The choice of antibiotic should be guided by local resistance patterns and adjusted based on culture results, as E. coli increasingly shows resistance to commonly used antibiotics due to extended-spectrum beta-lactamase (ESBL) production.
- Ciprofloxacin should only be used if the local resistance rate is <10% and the patient does not require hospitalization, and has not used fluoroquinolones in the last 6 months 1.
- Managing any urological abnormality and/or underlying complicating factors is crucial for effective treatment 1.
- Treatment duration typically ranges from 7-14 days depending on severity, with longer courses for patients with structural abnormalities, immunosuppression, or other complicating factors.
Alternative Options
- For patients with risk factors for resistant organisms, carbapenems such as meropenem (1g IV every 8 hours) may be necessary.
- Trimethoprim-sulfamethoxazole (160/800mg orally twice daily for 7-14 days) can be used if the organism is susceptible.
- Third-generation cephalosporins like ceftriaxone (1-2g IV daily) can also be used as an alternative option.
Recent Findings
- A recent study found that short-duration therapy (5-7 days) results in similar clinical success as long-duration therapy (10-14 days) for complicated UTI, even in patients with bacteremia 1.
- However, more data are needed in men to confirm that short-duration courses are as effective as long-duration courses for the treatment of complicated UTI 1.
From the FDA Drug Label
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 complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa Levofloxacin tablets are indicated for the treatment of acute pyelonephritis caused by Escherichia coli, including cases with concurrent bacteremia
Treatment for E. coli complicated UTI: Levofloxacin (PO) is indicated for the treatment of complicated urinary tract infections due to Escherichia coli.
- The treatment regimen may vary depending on the severity of the infection, with options for 5-day or 10-day treatment regimens. 2
From the Research
Treatment Options for E. coli Complicated 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 complicated UTIs, such as those caused by E. coli, treatment options include oral cephalosporins, fluoroquinolones, and β-lactams, such as amoxicillin-clavulanate 3.
- Parenteral treatment options for UTIs due to ESBLs-producing Enterobacteriales, including E. coli, include piperacillin-tazobactam, carbapenems, ceftazidime-avibactam, and aminoglycosides, including plazomicin 3.
- A retrospective review of ceftriaxone versus levofloxacin for treatment of E. coli urinary tract infections found that ceftriaxone seems to be an effective empiric therapy for most patients 4.
- Fluoroquinolones, such as ciprofloxacin and levofloxacin, are also effective against E. coli UTIs, but their use may be limited by resistance rates 5, 6.
Comparison of Antibiotic Therapies
- A systematic review and meta-analysis found no significant difference between levofloxacin and ciprofloxacin in terms of clinical success rate, microbial eradication rate, and adverse event rate for the treatment of UTIs 6.
- Another study found that the combination of a beta-lactam and a fluoroquinolone, such as cefepime and ciprofloxacin or levofloxacin, was synergistic against P. aeruginosa, but not necessarily against E. coli 7.
Considerations for Treatment
- The choice of empiric antibiotic therapy should be based on local antibiogram data and the patient's individual characteristics, such as recent exposure to antibiotics or risk of infections with ESBLs-producing Enterobacteriales 3, 4.
- It is essential to use new antimicrobials wisely to avoid resistance development and to consider the potential for synergistic activity between different antibiotic combinations 3, 7.