title: Successful Doxycycline Therapy in a Patient With Escherichia coli and Multidrug-Resistant Klebsiella pneumoniae Urinary Tract Infection.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  Doxycycline hyclate may be an effective treatment option for patients with susceptible MDR UTI.
authors.affiliation: 1 Husson University School of Pharmacy, Bangor, ME, USA.|2 VA Maine Healthcare System, Augusta, ME, USA.
authors.forename: Cassandra R
authors.initials: CR
authors.lastname: White
authors.affiliation: 2 VA Maine Healthcare System, Augusta, ME, USA.
authors.forename: Tomasz Z
authors.initials: TZ
authors.lastname: Jodlowski
authors.affiliation: 1 Husson University School of Pharmacy, Bangor, ME, USA.
authors.forename: Dylan T
authors.initials: DT
authors.lastname: Atkins
authors.affiliation: 1 Husson University School of Pharmacy, Bangor, ME, USA.
authors.forename: Nicole G
authors.initials: NG
authors.lastname: Holland
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D004318:Doxycycline / Q000494:pharmacology / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects* / Q000502:physiology; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000652:urine; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D008297:Male; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000652:urine
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline
keywords: bacterial resistance; doxycycline; infectious disease; urology