SOMETIMES this could be appropriate. Adverse drug reactions are likely to increase when more than one antibiotic is given at the same time. Some drugs interfere with each other, so it takes some study of which combination you are considering.
IN GENERAL, we usually try to treat with one class of antibiotic and see if the resistant organism can be cleared. Meropenem would be a drug to consider for treatment of MDR (multiple drug resistant) E.coli. Methenamine is also a consideration, as is Fosfomycin. Resistance to Fosfomycin is minimal for most uropathogens and even its “resistance” is not usually complete. Aminoglycosides are still very effective against most MDR E. coli - though potential nephrotoxicty is of course worrisome - sometimes this class is the only real option.
Using the upper dose of the flexible dose range for enrofloxacin (5 to 20 mg/kg) can be effective in eradicating seemingly resistant organisms due to the very high urinary concentrations of enrofloxacin and its ciprofloxacin metabolite that are achieved in general and even more so when higher doses are given. Most difficult UTI should be dosed at least 10mg/kg SID.
If there are TWO organisms and they have very different susceptibilities (as in neither organism is susceptible to the same drug) - I usually opt to treat the most pathogenic organism with one drug and see how things go. Often, if the one most pathogenic bug can be suppressed or eliminated, the other pathogen may also be taken out and cleared as host defenses improve.
SOMETIMES this could be appropriate. Adverse drug reactions are likely to increase when more than one antibiotic is given at the same time. Some drugs interfere with each other, so it takes some study of which combination you are considering.
IN GENERAL, we usually try to treat with one class of antibiotic and see if the resistant organism can be cleared. Meropenem would be a drug to consider for treatment of MDR (multiple drug resistant) E.coli. Methenamine is also a consideration, as is Fosfomycin. Resistance to Fosfomycin is minimal for most uropathogens and even its “resistance” is not usually complete. Aminoglycosides are still very effective against most MDR E. coli - though potential nephrotoxicty is of course worrisome - sometimes this class is the only real option.
Using the upper dose of the flexible dose range for enrofloxacin (5 to 20 mg/kg) can be effective in eradicating seemingly resistant organisms due to the very high urinary concentrations of enrofloxacin and its ciprofloxacin metabolite that are achieved in general and even more so when higher doses are given. Most difficult UTI should be dosed at least 10mg/kg SID.
If there are TWO organisms and they have very different susceptibilities (as in neither organism is susceptible to the same drug) - I usually opt to treat the most pathogenic organism with one drug and see how things go. Often, if the one most pathogenic bug can be suppressed or eliminated, the other pathogen may also be taken out and cleared as host defenses improve.
