Amoxicillin-Clavulanate for ESBL UTIs

A patient is prescribed cephalexin for a UTI by her primary care doctor. Two days later an ESBL P. mirabilis grows in culture. The only susceptible oral antibiotic is amoxicillin-clavulanate. Should she be admitted for IV antibiotics?

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Best Answer

Maybe

Explanation: The IDSA suggests against amoxicillin-clavulanate for cystitis/uncomplicated UTIs due to ESBL Enterobacterales, however it may be active in vitro, and success has been reported in observational studies. If selecting amoxicillin-clavulanate, higher doses and 7-day duration may be needed. With no other oral options, patients may still prefer amox-clav to avoid the burden of admission and IV antibiotics. Patient should be counseled on the possible higher risk for relapses or recurrence. Alternatives to consider include single dose intramuscular aminoglycosides, if susceptible and feasible.

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