Effective Oral Combination Treatment for Extended-Spectrum Beta-Lactamase-Producing<i>Escherichia coli</i>

Al‐Akchar, Mohammad; Abu-Raideh, Jumana; Albalawi, Hadeel; Shalabi, Marwan; Saleh, Saiel

doi:10.1089/mdr.2019.0065

Cited by 28 publications

(26 citation statements)

References 30 publications

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“…Nevertheless, these organisms produce the beta-lactamase enzyme which render them resistant to most classes of antibiotics, hence referred to as ESBL-producing organisms [ 21 ]. Nowadays, carbapenems are considered the treatment of choice for such organisms [ 22 ]. In our present study, we analyzed the epidemiology of UTI in Lebanese hospitals in South Lebanon over a period of 9 months.…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial Susceptibilities and Laboratory Profiles of Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis Isolates as Agents of Urinary Tract Infection in Lebanon: Paving the Way for Better Diagnostics

et al. 2020

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Background: Urinary tract infections (UTIs) are major healthcare problems that are usually treated empirically. However, antimicrobial resistance has been increasing across many settings. This study aims to elucidate the antibiotic resistance profiles of three common uropathogens, Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), and Proteus mirabilis (P. mirabilis) and compare between extended spectrum beta-lactamase (ESBL) and non-ESBL strains among Lebanese patients. Methods: This retrospective study was conducted at multiple tertiary healthcare centers in South Lebanon, between January and September 2017, including 551 patients of all age groups. Demographic, clinical, and laboratory data of patients were collected and analyzed statistically. Results: The prevalence of UTI in Lebanon was highest in adults between 19 and 64 years (44%). E. coli was the predominant uropathogenic organism (67.1%) followed by K. pneumoniae (10%) and P. mirabilis (3.7%). ESBL represented 32.9% of the UTI agents. The three common uropathogens studied were found to be most susceptible to imipenem (100%) and meropenem (100%). Interestingly, 115 (25.1%) out of the 458 E. coli isolates were resistant to more than eight antibiotics while 107 (23.4%) were susceptible to all antibiotics studied. Conclusions: Our study underlined the importance of adequate antimicrobial prescription for UTIs in Lebanon to avoid multidrug resistance.

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Section: Introductionmentioning

confidence: 99%

Antimicrobial Susceptibilities and Laboratory Profiles of Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis Isolates as Agents of Urinary Tract Infection in Lebanon: Paving the Way for Better Diagnostics

et al. 2020

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“…Other studies have investigated the clinical effectiveness of an oral third-generation cephalosporin combined with AC and found high clinical cure rates but in a smaller number of adults [ 18 , 19 ]. This situation emphasizes the need for larger prospective studies in children.…”

Section: Discussionmentioning

confidence: 99%

“…Another limitation might be the use of the E-test method for the DST of the ESBL-producing strains to the AC-cefixime combination because it is not standardized. However, several other studies, using various non-standardized methods [ 19 – 21 ], including the E-test [ 22 ], have shown in vitro synergy between third-generation cephalosporins and clavulanate. We chose the E-test because it can detect in vitro synergy between cefixime and clavulanate and for its ease of use in clinical laboratory settings [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Relay oral therapy in febrile urinary tract infections caused by extended spectrum beta-lactamase–producing Enterobacteriaceae in children: A French multicenter study

Lignieres

Birgy²,

Jung

et al. 2021

PLoS ONE

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Objectives We need studies assessing therapeutic options for oral relay in febrile urinary tract infection (FUTI) due to ESBL–producing Enterobacteriaceae (ESBL-E) in children. Amoxicillin-clavulanate/cefixime (AC-cefixime) combination seems to be a suitable option. We sought to describe the risk of recurrence at 1 month after the end of treatment for FUTI due to ESBL-E according to the oral relay therapy used. Materials and methods We retrospectively identified children <18 years who were included in a previous prospective observational multicentric study on managing FUTI due to ESBL-E between 2014 and 2017 in France. We collected whether children who received cotrimoxazole, ciprofloxacin or the AC-cefixime combination as the oral relay therapy reported a recurrence within the first month after the end of treatment. Then, we analyzed the susceptibility drug-testing of the strains involved. Results We included 199 children who received an oral relay therapy with cotrimoxazole (n = 72, 36.2%), ciprofloxacin (n = 38, 19.1%) or the AC-cefixime combination (n = 89, 44.7%). Nine (4.5%) patients had a recurrence within the first month after the end of treatment, with no difference between the 3 groups of oral relay (p = 0.8): 4 (5.6%) cotrimoxazole, 2 (5.3%) ciprofloxacin and 3 (3.4%) AC-cefixime combination. Phenotype characterization of 249 strains responsible for FUTI due to ESBL-E showed that 97.6% were susceptible to the AC-cefixime combination. Conclusions The AC-cefixime combination represents an interesting therapeutic option for oral relay treatment of FUTI due to ESBL-E as the recurrence rate at 1 month after the end of treatment was the same when compared to cotrimoxazole and ciprofloxacin.

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“…Such combinations are not approved in the USA and Europe, but are available in India [16]. In-vitro studies showed that MICs of these oral cephalosporins in the presence of clavulanate against ESBL isolates were below their respective susceptibility breakpoints [8,15,34]. Another potentially clinically beneficial approach is to combine amoxicillin/clavulanate with cefpodoxime or ceftibuten (both show high urinary concentrations) [34,35].…”

Section: Alternative Choices: Present and Futurementioning

confidence: 99%

“…In-vitro studies showed that MICs of these oral cephalosporins in the presence of clavulanate against ESBL isolates were below their respective susceptibility breakpoints [8,15,34]. Another potentially clinically beneficial approach is to combine amoxicillin/clavulanate with cefpodoxime or ceftibuten (both show high urinary concentrations) [34,35]. However, the benefit of clavulanate plus oral cephalosporin is limited to E. coli and K. pneumoniae since clavulanate is an inducer of chromosomal AmpC enzyme present in pathogens such as Enterobacter spp.…”

Section: Alternative Choices: Present and Futurementioning

confidence: 99%

Orally Administered Amoxicillin/Clavulanate: Current Role in Outpatient Therapy

2020

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Oral amoxicillin/clavulanate is a community workhorse antibiotic, routinely prescribed for respiratory tract infections, skin infections as well as urinary tract infections (UTIs). Multiple adult and paediatric dose formulations of amoxicillin/clavulanate are available in different parts of the world. In adult formulations, clavulanic acid dose is restricted to 125 mg because of tolerability issues. Despite its popular use for 40 years, few pharmacokinetic/pharmacodynamic (PK/PD) studies were undertaken to justify the doses and breakpoints currently in use for various infections. Clavulanate has a minimal role in the combination’s use for respiratory infections. In the context of rising extended spectrum beta-lactamase (ESBL) prevalence globally, empirical and overuse of orally administered amoxicillin/clavulanate may select resistance in Gram-negative pathogens. The susceptibility test methods and interpretive criteria differ between the Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST). Third-generation oral cephalosporins such as ceftibuten or cefpodoxime can be combined with amoxicillin/clavulanate to tackle UTIs involving ESBL producing Escherichia coli and Klebsiella spp. Clinicians who routinely prescribe amoxicillin/clavulanate in outpatient settings should be aware of potential benefits and limitations of this combination.

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Effective Oral Combination Treatment for Extended-Spectrum Beta-Lactamase-ProducingEscherichia coli

Cited by 28 publications

References 30 publications

Antimicrobial Susceptibilities and Laboratory Profiles of Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis Isolates as Agents of Urinary Tract Infection in Lebanon: Paving the Way for Better Diagnostics

Antimicrobial Susceptibilities and Laboratory Profiles of Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis Isolates as Agents of Urinary Tract Infection in Lebanon: Paving the Way for Better Diagnostics

Relay oral therapy in febrile urinary tract infections caused by extended spectrum beta-lactamase–producing Enterobacteriaceae in children: A French multicenter study

Orally Administered Amoxicillin/Clavulanate: Current Role in Outpatient Therapy

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