From the Guidelines
For Klebsiella pneumoniae urinary tract infections, the recommended treatment is a carbapenem, such as imipenem or meropenem, as targeted therapy for patients with severe infections, or piperacillin-tazobactam, amoxicillin/clavulanic acid, or quinolones for low-risk, non-severe infections, considering antibiotic stewardship. The choice of antibiotic treatment for Klebsiella pneumoniae urinary tract infections should be guided by the severity of the infection and the susceptibility of the organism.
- For patients with severe infections, a carbapenem, such as imipenem or meropenem, is recommended as targeted therapy 1.
- For patients with low-risk, non-severe infections, piperacillin-tazobactam, amoxicillin/clavulanic acid, or quinolones may be used, considering antibiotic stewardship 1.
- Aminoglycosides, such as plazomicin, may be used for short durations of therapy for patients with non-severe infections, including complicated urinary tract infections (cUTI) 1.
- The treatment duration should be extended to 10-14 days for complicated infections.
- Due to increasing antibiotic resistance in Klebsiella, treatment should ideally be guided by culture and sensitivity testing 1.
- 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.
- Klebsiella pneumoniae produces extended-spectrum beta-lactamases (ESBLs) that can inactivate many antibiotics, making proper antibiotic selection crucial for effective treatment. Some studies suggest that ciprofloxacin or levofloxacin may be used as first-line treatment for uncomplicated lower UTIs, but the choice of antibiotic should be guided by local resistance patterns and susceptibility testing 1. However, the most recent and highest quality study recommends a carbapenem, such as imipenem or meropenem, as targeted therapy for patients with severe infections, or piperacillin-tazobactam, amoxicillin/clavulanic acid, or quinolones for low-risk, non-severe infections, considering antibiotic stewardship 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 caused by Klebsiella pneumoniae, including both complicated and uncomplicated infections 2.
From the Research
Antibiotic Treatment for Klebsiella pneumoniae Urine Infections
- The emergence of carbapenem-resistant Klebsiella pneumoniae is a growing concern, and treatment failure can lead to the spread of resistance determinants 3.
- Factors such as male gender, upper urinary tract infections, invasive urinary maneuvers, and recent infection with or carriage of the germ can predict carbapenem-resistant Klebsiella pneumoniae infection 3.
- New antibiotic treatments such as cefiderocol, meropenem-vaborbactam, ceftazidim-avibactam, and imipenem-relebactam represent a major step forward in the treatment of Klebsiella pneumoniae carbapenemase-producers (KPCp) urinary tract infections (UTIs) 4.
Antibiotic Sensitivity Profiles
- A study in Karachi found that Klebsiella pneumoniae isolates from urine samples were most sensitive to imipenem (97.7%), followed by cefroperazone-sulbactam (95.8%) and piperacillin-tazobactam (95.7%) 5.
- Another study found that the initial addition of 1/4 MIC ciprofloxacin inhibited the growth of K. pneumoniae, and the ciprofloxacin treatments showed significant reduction in the number of K. pneumoniae cells compared to meropenem 6.
Treatment Options
- Cefazolin may be a ceftriaxone-sparing alternative treatment for antibiotic-susceptible K. pneumoniae bacteraemia, with no significant difference in 28-day all-cause mortality between the cefazolin and ceftriaxone groups 7.
- The choice of antibiotic treatment should be guided by the results of antibiotic sensitivity testing, and the use of new antibiotic treatments should be considered in the treatment of KPCp UTIs 4.