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Klebsiella Infections Medication

  • Author: Shahab Qureshi, MD; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Oct 06, 2015
 

Medication Summary

The following is a discussion on the specific agents used in the antimicrobial therapy of Klebsiella infections. In vitro data show that a wide range of beta-lactams, aminoglycosides, quinolones, and other antibiotics are useful for treatment of klebsiellae infections.[11, 12, 13]

Cephalosporins have been widely used as monotherapy and in combination with aminoglycosides. Cephalosporins should be avoided if ESBL strains are present. In such instances, the carbapenems, especially imipenem, are effective.

Aztreonam and quinolones are useful in patients allergic to penicillin, and rifampin has been used for treatment of rhinoscleroma. TMP/SMZ is not used in primary treatment of pneumonia. They may be used as initial treatment in uncomplicated UTI and as second-line agents for ozena.

For isolates that produce ESBLs and carbapenemases, see Treatment.

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Antibiotics

Class Summary

Therapy must cover all likely pathogens in the context of this clinical setting. Antibiotic selection should be guided by culture and sensitivity results whenever feasible.

Cefotaxime (Claforan)

 

Useful for most Klebsiella infections. Third-generation cephalosporin with gram-negative activity. Arrests bacterial cell wall synthesis, which, in turn, inhibits bacterial growth.

Ceftriaxone (Rocephin)

 

Effective for K pneumoniae meningitis and other Klebsiella infections. Third-generation cephalosporin with broad-spectrum, gram-negative activity and higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins.

Gentamicin (Garamycin, Jenamicin, Gentafair)

 

Aminoglycoside antibiotic for gram-negative coverage. Bactericidal drug that may be used synergistically with third-generation cephalosporins. Works by binding the bacterial 30S ribosomal subunit, thereby inhibiting protein synthesis. Dosing regimens are numerous; adjust dose based on CrCl and changes in volume of distribution. May be given IV/IM. Monitoring may be required because of the potential to cause cochlear, vestibular, and tubular damage.

Amikacin (Amikin)

 

For gram-negative bacterial coverage of infections resistant to gentamicin and tobramycin. Irreversibly binds to 30S subunit of bacterial ribosomes, blocks recognition step in protein synthesis, and causes growth inhibition. The same principles of drug monitoring for gentamicin apply to amikacin.

Piperacillin/tazobactam (Zosyn)

 

Antipseudomonal penicillin plus beta-lactamase inhibitor. Inhibits biosynthesis of cell wall mucopeptide and is effective during stage of active multiplication.

Imipenem/cilastatin (Primaxin)

 

When given alone, this beta-lactam carbapenem antibiotic is metabolized by renal dehydropeptidase I, resulting in metabolites toxic to the proximal tubule. Cilastatin is an inhibitor of this enzyme, ensuring adequate levels of imipenem.

Ciprofloxacin (Cipro)

 

Indicated for a variety of Klebsiella infections. May be used PO or IV. Inhibits bacterial DNA synthesis and, consequently, growth.

Aztreonam (Azactam)

 

Monobactam inhibits cell wall synthesis during bacterial growth. Active against gram-negative bacilli. Bactericidal.

Rifampin (Rifadin, Rimactane)

 

Inhibits DNA-dependent bacterial RNA polymerase. Indicated as second-line agent in select klebsiellae infections.

Trimethoprim/sulfamethoxazole (Bactrim, Bactrim DS, Septra DS, Cotrim)

 

Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Antibacterial activity of TMP-SMZ includes common urinary tract pathogens except Pseudomonas aeruginosa. Indicated as second-line agent for select infections. Not used for routine treatment of pneumonia.

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Contributor Information and Disclosures
Author

Shahab Qureshi, MD Attending Physician in General Internal Medicine, St Catharine's General Hospital; Associate Clinical Professor (Adjunct), McMaster University School of Medicine, Canada

Shahab Qureshi, MD is a member of the following medical societies: College of Physicians and Surgeons of Ontario, Ontario Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John W King, MD Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, Association of Subspecialty Professors, American Society for Microbiology, Infectious Diseases Society of America, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

David Hall Shepp, MD Program Director, Fellowship in Infectious Diseases, Department of Medicine, North Shore University Hospital; Associate Professor, New York University School of Medicine

David Hall Shepp, MD is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Received salary from Gilead Sciences for management position.

Acknowledgements

Leonard B Berkowitz, MD Chief, Divisions of Infectious Diseases and HIV/AIDS Services, Brooklyn Hospital Center; Clinical Assistant Professor, Department of Medicine, State University of New York at Brooklyn

Leonard B Berkowitz, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, Infectious Diseases Society of America, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Obiamiwe Umeh, MBBS Fellow, Center for AIDS Research and Education, David Geffen School of Medicine at UCLA

Obiamiwe Umeh, MBBS is a member of the following medical societies: American College of Physicians and American Medical Association

Disclosure: Nothing to disclose.

References
  1. Mandell. Enterobacteriaceae. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Churchill Livingstone, An Imprint of Elsevier; 2009.

  2. Nordmann P, Cuzon G, Naas T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis. 2009 Apr. 9(4):228-36. [Medline].

  3. Won SY, Munoz-Price LS, Lolans K, Hota B, Weinstein RA, Hayden MK. Emergence and Rapid Regional Spread of Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae. Clin Infect Dis. 2011 Sep. 53(6):532-540. [Medline].

  4. Livermore DM. Fourteen years in resistance. Int J Antimicrob Agents. 2012 Apr. 39(4):283-94. [Medline].

  5. Miftode E, Dorneanu O, Leca D, Teodor A, Mihalache D, Filip O, et al. [Antimicrobial resistance profile of E. coli and Klebsiella spp. from urine in the Infectious Diseases Hospital Iasi]. Rev Med Chir Soc Med Nat Iasi. 2008 Apr-Jun. 113(2):478-82. [Medline].

  6. Tu YC, Lu MC, Chiang MK, Huang SP, Peng HL, Chang HY, et al. Genetic requirements for Klebsiella pneumoniae-induced liver abscess in an oral infection model. Infect Immun. 2009 May 11. [Medline].

  7. Munoz-Price LS, Poirel L, Bonomo RA, Schwaber MJ, Daikos GL, Cormican M, et al. Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. Lancet Infect Dis. 2013 Sep. 13(9):785-96. [Medline].

  8. Fevre C, Passet V, Deletoile A, Barbe V, Frangeul L, Almeida AS, et al. PCR-based identification of Klebsiella pneumoniae subsp. rhinoscleromatis, the agent of rhinoscleroma. PLoS Negl Trop Dis. 2011 May. 5(5):e1052. [Medline]. [Full Text].

  9. Gupta N, Limbago BM, Patel JB, Kallen AJ. Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis. 2011 Jul 1. 53(1):60-7. [Medline].

  10. Doyle D, Peirano G, Lascols C, Lloyd T, Church DL, Pitout JD. Laboratory detection of Enterobacteriaceae that produce carbapenemases. J Clin Microbiol. 2012 Dec. 50(12):3877-80. [Medline]. [Full Text].

  11. Weisenberg SA, Morgan DJ, Espinal-Witter R, Larone DH. Clinical outcomes of patients with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae after treatment with imipenem or meropenem. Diagn Microbiol Infect Dis. 2009 Apr 1. [Medline].

  12. Chan YR, Liu JS, Pociask DA, Zheng M, Mietzner TA, Berger T, et al. Lipocalin 2 is required for pulmonary host defense against Klebsiella infection. J Immunol. 2009 Apr 15. 182(8):4947-56. [Medline].

  13. Adams-Haduch JM, Potoski BA, Sidjabat HE, Paterson DL, Doi Y. Activity of Temocillin against KPC-Producing Klebsiella pneumoniae and Escherichia coli. Antimicrob Agents Chemother. 2009 Mar 30. [Medline].

  14. Al-Rabea AA, Burwen DR, Eldeen MA, et al. Klebsiella pneumoniae bloodstream infections in neonates in a hospital in the Kingdom of Saudi Arabia. Infect Control Hosp Epidemiol. 1998 Sep. 19(9):674-9. [Medline].

  15. Anderson MJ, Janoff EN. Klebsiella endocarditis: report of two cases and review. Clin Infect Dis. 1998 Feb. 26(2):468-74. [Medline].

  16. Blaser J, Konig C, Simmen HP, Thurnheer U. Monitoring serum concentrations for once-daily netilmicin dosing regimens. J Antimicrob Chemother. 1994 Feb. 33(2):341-8. [Medline].

  17. Bodey GP, Elting LS, Rodriquez S, Hernandez M. Klebsiella bacteremia. A 10-year review in a cancer institution. Cancer. 1989 Dec 1. 64(11):2368-76. [Medline].

  18. Branger J, Florquin S, Knapp S. LPS-binding protein-deficient mice have an impaired defense against Gram-negative but not Gram-positive pneumonia. Int Immunol. 2004 Nov. 16(11):1605-11. [Medline].

  19. Einstein BI. Enterobacteriaceae. In: Mandell GL, Bennett JE, Dolin E, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Vol 2. 5th ed. New York, NY: Churchill Livingstone; 2000:. 2294-310.

  20. Farmer JJ. Enterobacteriaceae: Introduction and identification. In: Murray PR, Baron, EJ, Pfaller MA, eds. Manual of Clinical Microbiology. 7th ed. Washington, DC: American Society for Microbiology; 1999:. 438-47.

  21. Fisman DN, Kaye KM. Once-daily dosing of aminoglycoside antibiotics. Infect Dis Clin North Am. 2000 Jun. 14(2):475-87. [Medline].

  22. Gamea AM, el-Tatawi FA. The effect of rifampicin on rhinoscleroma: an electron microscopic study. J Laryngol Otol. 1990 Oct. 104(10):772-7. [Medline].

  23. Hirche TO, Gaut JP, Heinecke JW. Myeloperoxidase plays critical roles in killing Klebsiella pneumoniae and inactivating neutrophil elastase: effects on host defense. J Immunol. 2005 Feb 1. 174(3):1557-65. [Medline].

  24. Kaye KS, Fraimow HS, Abrutyn E. Pathogens resistant to antimicrobial agents. Epidemiology, molecular mechanisms, and clinical management. Infect Dis Clin North Am. 2000 Jun. 14(2):293-319. [Medline].

  25. Khimji PL, Miles AA. Microbial iron-chelators and their action on Klebsiella infections in the skin of guinea-pigs. Br J Exp Pathol. 1978 Apr. 59(2):137-47. [Medline].

  26. Kobashi Y, Fujita K, Karino T, et al. [Clinical analysis of community-acquired pneumonia requiring hospitalization in a community hospital--comparison of elderly and non-elderly patients]. Kansenshogaku Zasshi. 2000 Jan. 74(1):43-50. [Medline].

  27. Kobashi Y, Ohba H, Yoneyama H, et al. [Clinical analysis of patients with community-acquired pneumonia requiring hospitalization classified by age group]. Kansenshogaku Zasshi. 2001 Mar. 75(3):193-200. [Medline].

  28. Korvick JA, Bryan CS, Farber B, et al. Prospective observational study of Klebsiella bacteremia in 230 patients: outcome for antibiotic combinations versus monotherapy. Antimicrob Agents Chemother. 1992 Dec. 36(12):2639-44. [Medline].

  29. Liam CK, Lim KH, Wong CM. Community-acquired pneumonia in patients requiring hospitalization. Respirology. 2001 Sep. 6(3):259-64. [Medline].

  30. Lucente FE. Rhinitis and nasal obstruction. Otolaryngol Clin North Am. 1989 Apr. 22(2):307-18. [Medline].

  31. Mentec H, Vallois JM, Bure A, et al. Piperacillin, tazobactam, and gentamicin alone or combined in an endocarditis model of infection by a TEM-3-producing strain of Klebsiella pneumoniae or its susceptible variant. Antimicrob Agents Chemother. 1992 Sep. 36(9):1883-9. [Medline].

  32. Merino S, Camprubi S, Alberti S, et al. Mechanisms of Klebsiella pneumoniae resistance to complement-mediated killing. Infect Immun. 1992 Jun. 60(6):2529-35. [Medline].

  33. Nicolau DP, Freeman CD, Belliveau PP, et al. Experience with a once-daily aminoglycoside program administered to 2,184 adult patients. Antimicrob Agents Chemother. 1995 Mar. 39(3):650-5. [Medline].

  34. Paterson DL. Recommendation for treatment of severe infections caused by Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs). Clin Microbiol Infect. 2000 Sep. 6(9):460-3. [Medline].

  35. Paterson DL, Trenholme GM. Klebsiella species. In: Yu VL, Merigan TC, Barriere SL, eds. Antimicrobial therapy and vaccines. Baltimore, Md: Williams & Wilkins; 1999:. 239-48.

  36. Podschun R, Ullmann U. Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev. 1998 Oct. 11(4):589-603. [Medline].

  37. Prabaker K, Lin MY, McNally M, Cherabuddi K, Ahmed S, Norris A. Transfer from high-acuity long-term care facilities is associated with carriage of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae: a multihospital study. Infect Control Hosp Epidemiol. 2012 Dec. 33(12):1193-9. [Medline].

  38. Prince SE, Dominger KA, Cunha BA, Klein NC. Klebsiella pneumoniae pneumonia. Heart Lung. 1997 Sep-Oct. 26(5):413-7. [Medline].

  39. Restuccia PA, Cunha BA. Klebsiella. Infect Control. 1984 Jul. 5(7):343-7. [Medline].

  40. Rice L. Evolution and clinical importance of extended-spectrum beta-lactamases. Chest. 2001 Feb. 119(2 Suppl):391S-396S. [Medline].

  41. Riser E, Noone P, Howard FM. Epidemiological study of klebsiella infection in the special care baby unit of a London hospital. J Clin Pathol. 1980 Apr. 33(4):400-7. [Medline].

  42. Sahly H, Podschun R. Clinical, bacteriological, and serological aspects of Klebsiella infections and their spondyloarthropathic sequelae. Clin Diagn Lab Immunol. 1997 Jul. 4(4):393-9. [Medline].

  43. Sahly H, Podschun R, Ullmann U. Klebsiella infections in the immunocompromised host. Adv Exp Med Biol. 2000. 479:237-49. [Medline].

  44. Sedor J, Mulholland SG. Hospital-acquired urinary tract infections associated with the indwelling catheter. Urol Clin North Am. 1999 Nov. 26(4):821-8. [Medline].

  45. Segal-Maurer S, Mariano N, Qavi A, et al. Successful treatment of ceftazidime-resistant Klebsiella pneumoniae ventriculitis with intravenous meropenem and intraventricular polymyxin B: case report and review. Clin Infect Dis. 1999 May. 28(5):1134-8. [Medline].

  46. Sidjabat H, Nimmo GR, Walsh TR, Binotto E, Htin A, Hayashi Y, et al. Carbapenem resistance in Klebsiella pneumoniae due to the New Delhi Metallo-ß-lactamase. Clin Infect Dis. 2011 Feb. 52(4):481-4. [Medline].

  47. Toivanen P, Hansen DS, Mestre F. Somatic serogroups, capsular types, and species of fecal Klebsiella in patients with ankylosing spondylitis. J Clin Microbiol. 1999 Sep. 37(9):2808-12. [Medline].

  48. Tomas JM, Benedi VJ, Ciurana B, Jofre J. Role of capsule and O antigen in resistance of Klebsiella pneumoniae to serum bactericidal activity. Infect Immun. 1986 Oct. 54(1):85-9. [Medline].

  49. Urban AW, Craig WA. Daily dosage of aminoglycosides. Curr Clin Top Infect Dis. 1997. 17:236-55. [Medline].

  50. Warren JW. Catheter-associated urinary tract infections. Int J Antimicrob Agents. 2001 Apr. 17(4):299-303. [Medline].

  51. Zohar Y, Talmi YP, Strauss M, et al. Ozena revisited. J Otolaryngol. 1990 Oct. 19(5):345-9. [Medline].

  52. Moore PP, McGowan GF, Sandhu SS, Allen PJ. Klebsiella pneumoniae liver abscess complicated by endogenous endophthalmitis: the importance of early diagnosis and intervention. Med J Aust. 2015 Oct 5. 203 (7):300-1. [Medline].

 
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This scanning electron micrograph (SEM) reveals some of the ultrastructural morphologic features of Klebsiella pneumoniae. Courtesy of CDC/Janice Carr.
 
 
 
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