From the Guidelines
For complicated UTIs in patients with poor renal function, Plazomicin 15 mg/kg IV q12h is recommended as a treatment option due to its effectiveness against multidrug-resistant organisms and relatively low nephrotoxicity compared to aminoglycosides 1. The choice of IV antibiotic for complicated UTIs in patients with poor renal function should prioritize medications with minimal renal clearance and dose adjustment requirements.
- Plazomicin has been recommended for cUTI due to CRE with a weak recommendation and very low quality of evidence 1.
- The dose of Plazomicin is 15 mg/kg IV q12h, which should be adjusted based on renal function.
- Alternative options include Ceftazidime-avibactam 2.5 g IV q8h or Meropenem-vaborbactam 4 g IV q8h, but these may require more careful dose adjustment in patients with poor renal function 1.
- Aminoglycosides like gentamicin should generally be avoided due to their nephrotoxicity, especially in patients with poor renal function 1.
- Before starting antibiotics, urine cultures should be obtained to guide targeted therapy, and the initial empiric choice should consider local resistance patterns and be adjusted based on culture results.
- Treatment duration typically ranges from 5-7 days depending on clinical response, and monitoring renal function during treatment is essential 1.
- Transitioning to oral antibiotics should be considered once the patient improves clinically.
- It is essential to note that the treatment options and recommendations may vary based on the specific clinical scenario, local resistance patterns, and the patient's underlying health conditions.
From the FDA Drug Label
In patients treated for UTI, the microbiological success rates in the evaluable per protocol (EPP) analysis were 87.0% (40/46) for ertapenem and 90.0% (18/20) for ceftriaxone.
The best IV antibiotic for complicated UTI with poor renal function is not directly stated in the provided drug label. However, ertapenem is evaluated for the treatment of complicated urinary tract infection (UTI) in pediatric patients, with a microbiological success rate of 87.0% in the EPP analysis 2.
- Ertapenem may be considered as an option for complicated UTI.
- However, the label does not provide information on the use of ertapenem in patients with poor renal function for this specific indication.
- Caution should be exercised when using ertapenem in patients with renal impairment, as the label does not provide explicit guidance on dosing adjustments for this population.
From the Research
Treatment Options for Complicated UTI with Poor Renal Function
- For patients with complicated urinary tract infections (UTIs) and poor renal function, the choice of intravenous (IV) antibiotic is crucial.
- According to 3, parenteral treatment options for UTIs due to ESBLs-producing Enterobacteriales include piperacillin-tazobactam, carbapenems such as meropenem/vaborbactam, and ceftazidime-avibactam.
- A study published in 4 demonstrated the efficacy of meropenem in treating severe complicated UTIs, including in patients with poor renal function, with a dose adjustment to 1g every 12 hours for those with creatinine clearance below 50 ml/min.
- Another option is sulopenem, an intravenous and oral penem with activity against multidrug-resistant bacteria, as discussed in 5. However, its use in patients with poor renal function may require careful consideration of dosing and potential interactions.
- The management of complicated UTIs, including those with poor renal function, should be individualized based on patient variables and the infecting organism, as emphasized in 6.
- For complicated UTIs including acute pyelonephritis, meropenem-vaborbactam is a potential treatment option, especially for infections caused by KPC-producing Enterobacteriaceae, as noted in 7.
Key Considerations
- The choice of IV antibiotic should be guided by local susceptibility patterns and the severity of the infection.
- Dose adjustments may be necessary for patients with poor renal function to minimize the risk of toxicity.
- Combination therapy may be considered in certain cases, but the decision should be based on the specific clinical scenario and susceptibility patterns.
- Close monitoring of renal function and potential side effects is essential when using IV antibiotics in patients with poor renal function.