A patient is kept on ceftriaxone and amikacin, ESBL Klebsiella infection is detected . What will you do next?: (A) Continue with same antibiotic but in higher dose, (B) Change ceftriaxone and add ceftazidime, (C) Sta imipenem in place of ceftriaxone, (D) Remove Amikacin
Answer is C. 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).