From the Guidelines
For Klebsiella pneumoniae UTI, an intravenous third-generation cephalosporin, such as ceftriaxone, is recommended as empirical treatment, especially in cases with systemic symptoms, as per the European Association of Urology guidelines 1. This recommendation is based on the most recent and highest quality evidence available. The guidelines suggest using a combination of antibiotics, including amoxicillin plus an aminoglycoside or a second-generation cephalosporin plus an aminoglycoside, but also emphasize the importance of managing any urological abnormality and/or underlying complicating factors 1. Some key points to consider when treating Klebsiella pneumoniae UTI include:
- Local antibiotic resistance patterns and susceptibility testing should guide treatment due to increasing resistance 1.
- Fluoroquinolones, such as ciprofloxacin, should only be used if the local resistance rate is <10% and the patient does not require hospitalization 1.
- Carbapenems, such as meropenem-vaborbactam or imipenem-cilastatin-relebactam, may be necessary for complicated or severe infections, especially for extended-spectrum beta-lactamase (ESBL) producing strains 1.
- Treatment duration typically ranges from 7-14 days depending on severity, and adequate hydration and follow-up urine cultures after treatment completion are important to confirm resolution. It is essential to note that Klebsiella pneumoniae has natural resistance to ampicillin and amoxicillin, and increasing resistance to many antibiotics makes susceptibility testing crucial for optimal treatment selection 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 uncomplicated urinary tract infections (mild to moderate) due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus
Levofloxacin should be used for Klebsiella pneumoniae UTI, as it is indicated for the treatment of both complicated and uncomplicated urinary tract infections due to Klebsiella pneumoniae 2.
From the Research
Treatment Options for Klebsiella pneumoniae UTI
- The recommended treatment options for UTIs due to ESBLs- Klebsiella pneumoniae include nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin 3.
- For UTIs due to carbapenem-resistant Enterobacteriales (CRE), treatment options include ceftazidime-avibactam, meropenem/vaborbactam, imipenem/cilastatin-relebactam, colistin, fosfomycin, aztreonam, and amoxicillin-clavulanate 3.
- A study found that ciprofloxacin or levofloxacin can be considered as a carbapenem-sparing alternative for ESBL-producing E. coli or K. pneumoniae bacteremia, if active in vitro 4.
- Trimethoprim-sulfamethoxazole (TRS) can be a cost-effective long-term solution for patients with multidrug-resistant K. pneumoniae UTIs, with a study showing microbiological eradication and symptomatic relief in all patients 5.
- Fluoroquinolones have been shown to be an effective alternative treatment for KPLA, resulting in a shorter duration of i.v. therapy and hospital length of stay 6.
Antibiotic Resistance and Treatment
- High rates of resistance to trimethoprim-sulfamethoxazole and ciprofloxacin preclude their use as empiric treatment of UTIs in several communities, particularly if patients were recently exposed to them or are at risk of infections with extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriales 3.
- The use of new antimicrobials should be done wisely to avoid resistance development 3.
- A study highlighted the challenge of treating KPCp-UTIs and the need for a strategy to use new antibiotic treatments, including cefiderocol, meropenem-vaborbactam, ceftazidim-avibactam, and imipenem-relebactam 7.