Antibiotic Treatment for Enterobacter cloacae Infections

Introduction to Antibiotic Resistance

The Infectious Diseases Society of America recommends that clindamycin should be changed to an agent with documented susceptibility, such as ciprofloxacin, gentamicin, meropenem, or sulfamethoxazole-trimethoprim, as clindamycin has no activity against Enterobacter cloacae 1, 2
Clindamycin's spectrum is limited to gram-positive cocci and anaerobes, with no meaningful activity against gram-negative rods like Enterobacter species 1, 2

The guidelines explicitly state that gentamicin or fluoroquinolones are required for coverage of resistant gram-negative rods, while clindamycin covers only anaerobes and aerobic gram-positive cocci 1, 2
For uncomplicated wound infection/cellulitis, switch to oral ciprofloxacin 500-750 mg twice daily if patient is clinically stable and can tolerate oral therapy 3
For severe infection with systemic toxicity, use IV ciprofloxacin 400 mg every 12 hours or meropenem 1 g every 8 hours 1, 2
Consider gentamicin with appropriate monitoring for severe infections 1

Do not continue clindamycin, as there is zero activity against Enterobacter species, and continuing ineffective therapy risks treatment failure and progression of infection 1, 2