Antibiotic Treatment of Infections Due to Pseudomonas Aeruginosa and Related Species
| Infection | Antibiotics and Dosages | Other Considerations |
|---|---|---|
| Bacteremia | ||
| Nonneutropenic host | Monotherapy: Ceftazidime (2 g q8h IV) or cefepime (2 g q12h IV) Combination therapy: Piperacillin/tazobactam (3.375 g q4h IV) or imipenem (500 mg q6h IV) or meropenem (1 g q8h IV) or doripenem (500 mg q8h IV) plus Amikacin (7.5 mg/kg q12h or 15 mg/kg q24h IV) | Add an aminoglycoside for patients in shock and in regions or hospitals where rates of resistance to the primary β-lactam agents are high. Tobramycin may be used instead of amikacin (susceptibility permitting). The duration of therapy is 7 days for nonneutropenic patients. Neutropenic patients should be treated until no longer neutropenic. |
| Neutropenic host | Cefepime (2 g q8h IV) or all other agents (except doripenem) in above dosages | |
| Endocarditis | Antibiotic regimens as for bacteremia for 6-8 weeks | Resistance during therapy is common. Surgery is required for relapse. |
| Pneumonia | Drugs and dosages as for bacteremia, except that the available carbapenems should not be the sole primary drugs because of high rates of resistance during therapy | IDSA guidelines recommend the addition of an aminoglycoside or ciprofloxacin. The duration of therapy is 10-14 days. |
| Bone infection, malignant otitis externa | Cefepime or ceftazidime at the same dosages as for bacteremia; aminoglycosides not a necessary component of therapy; ciprofloxacin (500-750 mg q12h PO) may be used | Duration of therapy varies with the drug used (e.g., 6 weeks for a β-lactam agent; at least 3 months for oral therapy except in puncture-wound osteomyelitis, for which the duration should be 2-4 weeks). |
| Central nervous system infection | Ceftazidime or cefepime (2 g q8h IV) or meropenem (1 g q8h IV) | Abscesses or other closed-space infections may require drainage. The duration of therapy is ≥2 weeks. |
Eye infection Keratitis/ulcer | Topical therapy with tobramycin/ciprofloxacin/levofloxacin eyedrops | Use maximal strengths available or compounded by pharmacy. Therapy should be administered for 2 weeks or until the resolution of eye lesions, whichever is shorter. |
| Endophthalmitis | Ceftazidime or cefepime as for central nervous system infection | |
| plus | ||
| Topical therapy | ||
| Urinary tract infection | Ciprofloxacin (500 mg q12h PO) or levofloxacin (750 mg q24h) or any aminoglycoside (total daily dose given once daily) | Relapse may occur if an obstruction or a foreign body is present. The duration of therapy for complicated UTI is 7-10 days (up to 2 weeks for pyelonephritis). |
| Multidrug-resistant P. aeruginosa infection | Colistin (100 mg q12h IV) for the shortest possible period to obtain a clinical response | Doses used have varied. Dosage adjustment is required in renal failure. Inhaled colistin may be added for pneumonia (100 mg q12h). |
| Stenotrophomonas maltophilia infection | TMP-SMX (1600/320 mg q12h IV) plusticarcillin/clavulanate (3.1 g q4h IV) for 14 days | Resistance to all agents is increasing. Levofloxacin or tigecycline may be alternatives, but there is little published clinical experience with these agents. |
| Burkholderia cepacia infection | Meropenem (1 g q8h IV) or TMP-SMX (1600/320 mg q12h IV) for 14 days | Resistance to both agents is increasing. Do not use them in combination because of possible antagonism. |
| Melioidosis, glanders | Ceftazidime (2 g q6h) or meropenem (1 g q8h) or imipenem (500 mg q6h) for 2 weeks | |
followed by TMP-SMX (1600/320 mg q12h PO) for 3 months |
Abbreviations: IDSA, Infectious Diseases Society of America; TMP-SMX, trimethoprim-sulfamethoxazole.