Antibiotic Treatment of Infections Due to Pseudomonas aeruginosa and Related Species | ||
| INFECTION | ANTIBIOTICS AND DOSAGES | OTHER CONSIDERATIONS |
|---|---|---|
| Bacteremia | ||
| Nonneutropenic host | Ceftazidime (2 g q8h IV) or cefepime (2 g q8h IV) or 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) Optional: Amikacin (7.5 mg/kg q12h or 15 mg/kg q24h IV) | Add an aminoglycoside for pts 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 pts. Neutropenic pts should be treated until no longer neutropenic. |
| Neutropenic host | Cefepime (2 g q8h IV) or all the other agents above (except doripenem) in the 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 7 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 | Ceftazidime/avibactam (2.5 g q8h, infused over 2 h) or ceftolozane/tazobactam (1.5 g q8h) or colistin (100 mg q12h IV for the shortest possible period to obtain a clinical response) | Higher doses of ceftolozane/tazobactam may be required for pneumonias. The colistin doses used have varied. Dosage adjustment for colistin is required in renal failure. Inhaled colistin may be added for pneumonia (100 mg q12h). |
| 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 (B. pseudomallei), glanders (B. mallei) | 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 | |
| Stenotrophomonas maltophilia infection | TMP-SMX (1600/320 mg q12h IV) plus ticarcillin/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. |
Abbreviations: IDSA, Infectious Diseases Society of America; TMP-SMX, trimethoprim-sulfamethoxazole.