What are the oral antibiotics (abx) for a urinary tract infection (UTI) caused by Klebsiella?

From the Guidelines

For the treatment of a urinary tract infection (UTI) caused by Klebsiella, oral Ciprofloxacin 500 mg or 750 mg twice daily for 14 days is recommended as the first line treatment. This recommendation is based on the British Thoracic Society guideline for bronchiectasis in adults, which suggests Ciprofloxacin as a suitable option for treating Coliforms, including Klebsiella 1. It's essential to note that the choice of antibiotic should consider local resistance patterns and patient-specific factors.

• The dosage and duration of treatment may vary depending on the severity of the infection and patient response.
• Patients should be advised to complete the full course of antibiotics, even if symptoms improve quickly, to ensure effective treatment and prevent recurrence.
• Increasing fluid intake and using phenazopyridine 200 mg three times daily for 2 days can help relieve urinary pain.
• If symptoms worsen or don't improve within 48-72 hours, medical reassessment is necessary, as Klebsiella can sometimes be resistant to multiple antibiotics, potentially requiring intravenous therapy.
• In cases where Ciprofloxacin is not suitable, intravenous Ceftriaxone 2G once daily for 14 days can be considered as a second-line treatment 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 uncomplicated urinary tract infections (mild to moderate) due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus.

Levofloxacin is indicated for the treatment of urinary tract infections (UTIs) caused by Klebsiella pneumoniae, including both complicated and uncomplicated cases.

• The treatment of complicated UTIs due to Klebsiella pneumoniae is supported by the drug label 2 and 2.
• The treatment of uncomplicated UTIs due to Klebsiella pneumoniae is also supported by the drug label 2 and 2.

From the Research

Oral Antibiotics for UTI caused by Klebsiella

• The treatment options for UTIs due to ESBLs- Klebsiella pneumoniae include pivmecillinam, fosfomycin, finafloxacin, and sitafloxacin 3.
• Amoxicillin-clavulanic acid (AMC) may be a good oral antimicrobial for treatment of ESBL-positive UTIs, if the causative agent is susceptible to this antibiotic 4.
• However, some strains may develop resistance during therapy, especially in those exhibiting high AMC MICs 4.
• Nitrofurantoin and amoxicillin/clavulanate demonstrated high non-ESBL E. coli susceptibilities, but their effectiveness against Klebsiella is not as well established 5.
• Klebsiella pneumoniae is one of the common uropathogens associated with urinary tract infections (UTIs) in residential care, with a prevalence of 8% 5.

Antibiotic Susceptibility

• All-pathogen susceptibilities were 79.6% (amoxicillin/clavulanate), 64.1% (nitrofurantoin), 50.5% (sulfamethoxazole/trimethoprim), 43.7% (cephalexin), 42.7% (amoxicillin), and 41.8% (ciprofloxacin) 5.
• Amoxicillin/clavulanate (96.7%), nitrofurantoin (90.0%) and sulfamethoxazole/trimethoprim (83.3%) demonstrated the highest non-ESBL E. coli susceptibilities 5.
• The susceptibility of Klebsiella pneumoniae to these antibiotics is not as well established, and may vary depending on the specific strain and location 3, 4, 5.

Treatment Outcomes

• Successful clinical and microbiologic responses were observed in 16 patients (76%) with UTIs caused by KPC-producing Enterobacteriaceae, including Klebsiella pneumoniae 6.
• Patients with urinary catheters had them removed or replaced in 9 of 15 cases (60%), which may have contributed to the successful treatment outcomes 6.
• Aminoglycosides and tetracycline derivatives suggested therapeutic promise in the treatment of KPC-producing Enterobacteriaceae UTI, including Klebsiella pneumoniae 6.