A patient is kept on ceftriaxone and amikacin, ESBL Klebsiella infection is detected . What will you do next?
1. b-lactamase enzymes are capable of hydrolysing the b-lactam rings (the active site) of b-lactam antibiotics; thereby deactivating their antibacterial propeies. ESBL is a Class A b-lactamase enzyme. 2. ESBL (Extended spectrum beta lactamases) are resistant to all Penicillin and 1st/2nd/3rd cephalosporin and monobactam. 3. But do not affect cephamycins (e.g., cefoxitin and cefotetan) or carbapenems (e.g., meropenem or imipenem).
Continue with same antibiotic but in higher dose
Change ceftriaxone and add ceftazidime
Sta imipenem in place of ceftriaxone
Remove Amikacin
Bacterial Treatment