Successful Doxycycline Therapy in a Patient With Escherichia coli and Multidrug-Resistant Klebsiella pneumoniae Urinary Tract Infection

Case Reports

. 2017 Aug;30(4):464-467.

doi: 10.1177/0897190016642362.

Epub 2016 Apr 12.

Cassandra R White 
^1
 
2
, Tomasz Z Jodlowski 
²
, Dylan T Atkins 
¹
, Nicole G Holland 
¹

Affiliations

Affiliations

• ¹ 1 Husson University School of Pharmacy, Bangor, ME, USA.
• ² 2 VA Maine Healthcare System, Augusta, ME, USA.

• PMID:

  27071978

• DOI:

  10. 1177/0897190016642362

Case Reports

Cassandra R White et al.

J Pharm Pract.

2017 Aug.

. 2017 Aug;30(4):464-467.

doi: 10.1177/0897190016642362.

Epub 2016 Apr 12.

Authors

Cassandra R White 
^1
 
2
, Tomasz Z Jodlowski 
²
, Dylan T Atkins 
¹
, Nicole G Holland 
¹

Affiliations

• ¹ 1 Husson University School of Pharmacy, Bangor, ME, USA.
• ² 2 VA Maine Healthcare System, Augusta, ME, USA.

• PMID:

  27071978

• DOI:

  10.1177/0897190016642362

Abstract

Objective:

To report on a patient with a symptomatic, polymicrobial Escherichia coli and multidrug-resistant (MDR), extended-spectrum β-lactamase (ESBL)-positive Klebsiella pneumoniae urinary tract infection (UTI) who was successfully treated with oral doxycycline hyclate.

Case summary:

A 70-year-old white male inpatient with a history of recurrent UTI, type 2 diabetes, hypertension, obesity, and diverticular disease was diagnosed with UTI and empirically treated with oral ciprofloxacin. Symptoms persisted 2 days later, and the patient was transitioned to amoxicillin/clavulanate by a different provider. The next day, upon receipt of the urine culture and susceptibility panel revealing E coli and MDR, ESBL-positive K pneumoniae infection, treatment was switched to doxycycline hyclate, which resulted in clinical improvement.

Discussion:

Complicated UTI involving multiple pathogens requires careful clinical judgment to select the appropriate antimicrobial agent, improve clinical outcomes, and prevent resistance. Treatment with doxycycline was based on the susceptibility panel and local resistance patterns. Advantages of doxycycline for UTI include its oral formulation, wide spectrum of activity, ability to achieve high concentration in the urine, and low toxicity.

Conclusion:

Doxycycline hyclate may be an effective treatment option for patients with susceptible MDR UTI.

Keywords:

bacterial resistance; doxycycline; infectious disease; urology.

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Women frustrated over UTI treatments

LOS ANGELES (CNS) — A study by researchers at UCLA and Cedars-Sinai released Thursday has found that women with frequent urinary tract infections are unhappy with what they perceive as doctors’ overuse of antibiotics and limited treatment options.

The research, recently published in the Journal of Urology, highlights the need for physicians to do a better job finding out why patients get recurrent UTIs, to develop preventative strategies and to avoid unnecessary use of antibiotics, which can lead to resistance to the medication.

“Since there’s already a common treatment for UTIs — antibiotics — many doctors don’t see a need to do anything differently,” said senior author Dr. Ja-Hong Kim, associate professor of urology and assistant fellowship director for Female Pelvic Medicine and Reconstructive Surgery at UCLA Health. “This study really gave us insight into the patient perspective and showed us those with recurrent UTIs are dissatisfied with the current management of the condition. Continued episodes can have a major impact on their quality of life.”

More than half of women will develop a UTI at some point, and roughly 1 in 4 will have repeat infections that can last for years. Many with recurrent infections will be prescribed antibiotics frequently over their lifetime.

The researchers conducted focus groups with 29 women with recurrent UTIs — defined as two infections in six months or three in a year. Participants were asked about their knowledge of UTIs, prevention strategies and the impact of treatment on their quality of life. These discussions, the researchers said, revealed two common themes: fear and frustration.

Participants’ concerns centered primarily on antibiotic use. The women reported a fear of being prescribed multiple courses of antibiotics unnecessarily and developing resistance. Some also reported being treated with antibiotics for symptoms that may have been related to other genitourinary conditions, like an overactive bladder.

“Other bladder diseases can cause symptoms similar to recurrent UTIs, such as urination frequency and urgency, pain with urination and blood in the urine,” Kim said. “These could be signs of an overactive bladder, interstitial cystitis, kidney or bladder stones or something more serious, like bladder cancer. As physicians, we really need to be careful about not just giving patients with these symptoms antibiotics without verifying a UTI through a positive urine culture.”

Because a diagnosis currently takes 48 hours, women can wait days before being prescribed the right treatment. These realities clearly spotlight the need for better diagnostic tools, Kim said.

Many participants voiced frustration and resentment toward their medical providers for “throwing antibiotics” at them without presenting alternative options for treatment and prevention, and for not understanding their experience with UTIs. In addition, many said their physicians did not properly educate them on the potential negative impacts of antibiotics; the participants instead had to rely on information from the internet, magazines and TV.

Beyond improved diagnostics, treatment approaches and guidelines, better patient education is key, Kim said. “We need to do a better job of letting patients know when antibiotics are necessary and when to consider alternative therapy for bladder conditions other than UTIs.”

Kim and her colleagues are working to improve UTI diagnosis and management, including developing comprehensive patient-care pathways through which primary care physicians and general gynecologists and urologists will provide initial UTI patient education and management. They are also pursuing studies examining the relationship of the vaginal microbiome to lower urinary tract symptoms and are working to incorporate novel diagnostic methods to allow for point-of-care treatment for UTIs in the hopes of improving patient care.

The study’s first author is Victoria Scott, of Cedars-Sinai. Other authors are Taylor Sadun and A. Lenore Ackerman, of UCLA; Melissa Markowitz, of Yale University; Lauren Thum, of Urology Specialists in Sioux Falls, South Dakota; Sally Maliski, of the University of Kansas Medical Center; and Jennifer Anger, of Cedars-Sinai.

Doxycycline 200 solution for injection : instructions for use, description, contraindications

Benefits

• Last generation tetracycline antibiotic.
• Effective at low concentrations and therefore less toxic.
• Prolonged development of resistance in microorganisms.

Composition and pharmacological properties.

It contains doxycycline hyclate as an active ingredient – 200 mg / ml. Doxycycline hyclate is an antibiotic of the tetracycline group, active against Escherichia coli., Yersinia enterocolitica, Bordettela pertussis, Shigella spp., Haemophilus spp., Pasteurella spp., Salmonella spp. , Staphylococcus spp., Streptococcus spp., Klebsiella pneumoniae, Leptospira spp., Clo stridium spp., Listeria monocytogenes, Corynebacterium pyogenes, Erysipelothrix rhusiopathiae, Fusobacterium necroforum, Actinobacillus spp., Rickettsiae spp., Chlamidia spp, and also Mycoplasma spp.

Indications for use.

Pigs, cattle and small cattle with colibacillosis, salmonellosis, staphylococcosis, pneumonia, hemophilia, swine enzootic pneumonia, swine erysipelas, pasteurellosis, foot rot, keratoconjunctivitis, wound infections, arthritis, umbilical sepsis, abscesses, chlamydia and other diseases of bacterial and mi coplasmic etiology.

Contraindications.

It is forbidden to use the drug for pregnant and lactating females. When using drugs of the tetracycline group in young animals during the formation and growth of teeth, a change in the color of the enamel is possible. Do not use Doxycycline 200 simultaneously with bactericidal antibiotics, as well as calcium and iron preparations due to a possible decrease in its activity. It is not recommended to mix in the same syringe with other drugs.

Application procedure.

“Doxycycline 200” is administered to animals intramuscularly once in the following doses: cattle and small cattle – 1.0 ml per 10 kg of animal weight; pigs – 0.5 ml per 10 kg of animal weight. If necessary, the drug is used again after 48 hours.

Due to the possible pain reaction, the maximum volume for administering the drug in one place should not exceed 2.5 ml for piglets, kids and lambs, 5 ml for adult pigs, sheep, goats and calves, and 10 ml for cattle.

Side effects.

When using the drug in accordance with the instructions, side effects and complications, as a rule, are not observed. In rare cases, edema may develop at the injection site, which resolves spontaneously within a few days.

With increased individual sensitivity of the animal to tetracyclines and the occurrence of allergic reactions, the use of the drug is stopped and desensitizing therapy is carried out.

Waiting period

Slaughter of animals for meat is allowed no earlier than 21 days after the last use of the drug. The meat of animals forcedly slaughtered before the expiration of the specified period may be used as feed for fur-bearing animals.

Storage.

Store the medicinal product in the manufacturer’s closed packaging in a dry place, protected from direct sunlight, out of the reach of children and animals, separately from food and feed, at a temperature of 5 °C to 25 °C.

Doxycycline-complex solution for oral administration: instructions for use, description, contraindications

Advantages:

• A new antibiotic of the tetracycline series.
• A unique combination of antibiotic, mucolytic and prebiotic.
• Effective and safe.
• Convenient form of application – with drinking water.

Composition and pharmacological properties.

As active ingredients, 1 ml contains doxycycline hyclate – 100 mg, bromhexine hydrochloride – 5 mg and, as an auxiliary substance, lactulose – 100 mg. Doxycycline hyclate is an antibiotic of the tetracycline group, active against Bordetella spp., Campylobacter spp., Escherichia coli, Haemophilus spp., Pasteurella spp., Salmonella spp., Staphylococcus spp., Streptococcus spp., Clostridium perfringens, Chlamydia spp., Rickettsiae spp., and Mycoplasma gallisepticum and Mycoplasma hyopneumoniae. Bromhexine is a mucolytic agent that has a secretolytic, expectorant and antitussive effect. Lactulose is a prebiotic, a disaccharide.

Indications for use.

Pigs and poultry with respiratory and gastrointestinal diseases of bacterial etiology, including salmonellosis, dysentery, enzootic pneumonia, pasteurellosis, mycoplasmosis, colibacillosis and other infections, the pathogens of which are sensitive to doxycycline.

Contraindications.

Increased individual sensitivity to the components of the drug. It is forbidden to use the drug in laying hens, animals with severe renal and hepatic insufficiency. The simultaneous use of the Doxycycline complex with muscle relaxants, substances that suppress the cough center, antibiotics of the penicillin and cephalosporin groups, mineral supplements and drugs containing calcium, magnesium, iron and aluminum salts is not allowed. Doxycycline may increase skin photosensitivity.

Application procedure.

Apply orally with drinking water at a daily dose of 0.5 ml per 1 liter of drinking water for 3-5 days. Pigs and poultry should only receive drug-containing water during the treatment period. If this is not possible, the daily dose of the drug is divided into 2 equal parts and drunk with an interval of 12 hours.

Side effects.

In the event of allergic reactions, the use of the drug is stopped and antihistamines and symptomatic drugs are prescribed.

Waiting period.

Slaughter of pigs for meat is allowed no earlier than 8 days, birds – 7 days after the last use of the drug. The meat of animals forcedly slaughtered before the expiration of the specified period may be used as feed for fur-bearing animals.

Storage.

Store the drug in a closed manufacturer’s packaging in a dry place, protected from direct sunlight, out of the reach of children and animals, separately from food and feed, at a temperature of 5 °C to 25 °C.