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If enterococcal UTI is suspected
(e.g., a urinary catheter in place, instrumentation of the urinary tract, anatomical abnormality — i.e., complicated pyelonephritis)
add ampicillin.
When should I add ampicillin empirically in the treatment of acute pyelonephritis?
Only when I’m using aminoglycosides?
Or is it okay to add it along with a cephalosporin?
In that case, is it acceptable to use two beta-lactams together?
I found different recommendations in several references, so I’m not sure which is correct.
…
Original question:
if enterococcal UTI is suspected (
a urinary Catheter in place , instrumentation of the urinary tract , anatomical abnormality (complicated Pyelonephritis ))
add ampicillin
متي بقي بضيف ال
ampicillin empirical
في علاج
acute Pyelonephritis
لما بكون مستخدمه بس
aminoglycosides
ولا عادي بيضاف مع السيفالوسبورين
وفي الحالة ديه عادي استخدم اتنين بيتا لاكتام
لاقتها في كذا ريفرينس مختلفة فمش عارفه ايه الاصح
The risk factors that suggest you might be dealing with an enterococcal UTI include:
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Presence of a urinary catheter
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Recent instrumentation of the urinary tract
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Anatomical abnormalities (which are common in complicated pyelonephritis)
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A known history of enterococcal infections
…
Antibiotic Combination Considerations
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Using Aminoglycosides:
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Synergy: When using an aminoglycoside, adding ampicillin is well supported by evidence because it creates a synergistic effect against Enterococcus. Aminoglycosides alone are not sufficient for treating enterococcal infections.
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Recommendation: In patients with risk factors for enterococcal infection, an ampicillin plus aminoglycoside combination is preferred for synergy and effective coverage.
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Using Cephalosporins:
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Cephalosporin Limitations: Cephalosporins do not have reliable activity against Enterococcus. Therefore, if your baseline regimen is a cephalosporin and you suspect an enterococcal infection, it is necessary to add ampicillin to cover this gap.
- Generally we will recommend against dual beat-lactam use.
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Dual Beta-Lactam Issue: Although combining two beta-lactams (ampicillin and a cephalosporin) is not typically considered synergistic (and might even be antagonistic in some cases), in an empiric setting it can be acceptable if:
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There is a broad need to cover other gram-negative pathogens with the cephalosporin,
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And there is a specific concern for Enterococcus that requires ampicillin.
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Once culture results become available, it is important to de-escalate therapy to the most targeted regimen.
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