From the Guidelines
For outpatient treatment of Klebsiella pneumoniae urinary tract infections, a combination of amoxicillin plus an aminoglycoside or a second-generation cephalosporin plus an aminoglycoside is recommended as a strong option, according to the European Association of Urology guidelines 1.
Treatment Options
- Amoxicillin plus an aminoglycoside: This combination is recommended as a strong option for the treatment of complicated UTIs, including those caused by Klebsiella pneumoniae 1.
- Second-generation cephalosporin plus an aminoglycoside: This combination is also recommended as a strong option for the treatment of complicated UTIs, including those caused by Klebsiella pneumoniae 1.
- Ciprofloxacin: This antibiotic may be used if the local resistance rate is <10% and the patient does not require hospitalization, but its use is not recommended if the patient has used fluoroquinolones in the last 6 months or has anaphylaxis to beta-lactam antimicrobials 1.
Considerations
- Local resistance patterns and culture results should guide treatment selection, as Klebsiella pneumoniae increasingly shows resistance to multiple antibiotics.
- Patients should complete the full course of antibiotics even if symptoms improve, drink plenty of fluids, and seek medical attention if symptoms worsen or don't improve within 48-72 hours of starting treatment, as this may indicate resistance requiring alternative therapy.
Alternative Options
- Other antibiotics, such as trimethoprim-sulfamethoxazole, nitrofurantoin, and beta-lactams like amoxicillin-clavulanate, may be considered for outpatient treatment of Klebsiella pneumoniae urinary tract infections, but their effectiveness may vary depending on local resistance patterns and patient factors 1.
From the FDA Drug Label
Ciprofloxacin Tablets USP, 250 mg, 500 mg and 750 mg is indicated for the treatment of infections caused by susceptible strains of the designated microorganisms in the conditions and patient populations listed below. Adult Patients: Urinary Tract Infections caused by Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, Proteus mirabilis, Providencia rettgeri, Morganella morganii, Citrobacter diversus, Citrobacter freundii, Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus epidermidis, Staphylococcus saprophyticus, or Enterococcus faecalis
- Klebsiella pneumoniae coverage: Ciprofloxacin is indicated for the treatment of urinary tract infections caused by Klebsiella pneumoniae in adult patients.
- Outpatient treatment: Ciprofloxacin can be used for outpatient treatment of urinary tract infections, including those caused by Klebsiella pneumoniae, as it is available in oral formulation 2.
From the Research
Treatment Options for Klebsiella pneumoniae UTI
- For outpatient treatment of Klebsiella pneumoniae urinary tract infections (UTIs), several oral antibiotic options are available, including nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin 3.
- In cases of extended-spectrum β-lactamases (ESBLs)-producing Klebsiella pneumoniae, oral treatment options include pivmecillinam, fosfomycin, finafloxacin, and sitafloxacin 3.
- Parenteral treatment options for UTIs due to ESBLs-producing Enterobacteriales include piperacillin-tazobactam, carbapenems, ceftazidime-avibactam, and ceftolozane-tazobactam 3.
Antibiotic Resistance and Treatment Efficacy
- The efficacy of antibiotics against Klebsiella isolates from urine samples has been assessed in several studies, with varying results 4, 5.
- A study found that aminoglycosides were effective in treating carbapenem-resistant Klebsiella pneumoniae (CRKP) UTIs, while tigecycline was associated with a higher risk of treatment failure 4.
- Another study found that trimethoprim-sulfamethoxazole (TRS) can be a cost-effective long-term solution for patients with multidrug-resistant K. pneumoniae UTIs, with microbiological eradication and symptomatic relief achieved in all patients 6.
Choice of Antibiotic Therapy
- The choice of antibiotic therapy for Klebsiella pneumoniae UTIs should be guided by local susceptibility patterns and the patient's medical history 3, 7.
- In cases of carbapenem-resistant Klebsiella pneumoniae, treatment options include cefiderocol, meropenem-vaborbactam, ceftazidime-avibactam, and imipenem-relebactam 7.
- The use of new antibiotic treatments, such as cefiderocol and meropenem-vaborbactam, may provide effective treatment options for UTIs caused by multidrug-resistant Klebsiella pneumoniae 7.