43yo female comes to clinic with dysuria and frequency. Urine culture grows E. Coli ESBL. How do you treat her?
a. Ertapenem x 3 days
b. Ertapenem x 7 days
c. fosfomycin
d. cipro
This patient has an uncomplicated cystitis which generally warrants 3 days of treatment with antibiotics. Having an ESBL urine infection does not automatically qualify the infection as complicated, thus a 7-10 day course is unnecessary. Fosfomycin has been shown in studies to be an effective oral therapy for uncomplicated cystitis from ESBL. One study had antimicrobial susceptibility testing was carried out on isolates of E.Coli ESBL in the outpatient setting. "Susceptibility rates indicate that
fosfomycin (97%), nitrofurantoin (94%), and pivmecillinam (85%) could be
considered important oral treatment options."
here are some articles on the subject
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935012/
http://www.ncbi.nlm.nih.gov/pubmed/17189097
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2809%2970325-1/abstract
