What medication is recommended to treat Pasteurella multocida bacteremia and for what duration?

From the Guidelines

For Pasteurella multocida bacteremia, the recommended first-line treatment is intravenous ampicillin-sulbactam (1.5-3g every 6 hours) or amoxicillin-clavulanate (1.2g every 8 hours) for severe infections, as these antibiotics have been shown to be effective against P. multocida in the most recent and highest quality study 1. The treatment duration typically ranges from 10-14 days, with consideration for longer courses in complicated cases such as endocarditis or osteomyelitis.

• Key considerations for treatment include:
  • The use of beta-lactam/beta-lactamase inhibitor combinations, such as ampicillin-sulbactam, which are more reliable due to the production of beta-lactamases by P. multocida 1
  • The effectiveness of doxycycline (100mg twice daily), fluoroquinolones like ciprofloxacin (400mg IV twice daily or 500-750mg oral twice daily), or trimethoprim-sulfamethoxazole as alternative treatments for penicillin-allergic patients 1
  • The importance of addressing the source of infection, such as animal bites or respiratory infections, to prevent recurrence Once clinical improvement occurs, patients can be transitioned to oral amoxicillin-clavulanate (875/125mg twice daily) to complete the treatment course.
• It is also important to note that:
  • Blood cultures should be repeated to confirm clearance of bacteremia
  • The treatment should be guided by the results of culture and susceptibility testing, if available
  • The use of broader empirical coverage for abscesses might yield better therapeutic results, while a more focused therapy for nonpurulent infected wounds could allow narrower therapy 1

From the Research

Treatment of Pasteurella Multocida Bacteremia

• The preferred treatment for Pasteurella multocida infections is penicillin or its derivatives 2.
• Other effective antimicrobial agents against P. multocida include:
  • Second- and third-generation cephalosporins 3, 4
  • Fluoroquinolones 3, 4
  • Tetracyclines 3, 5
  • Trimethoprim/sulfamethoxazole 3, 4
• Aztreonam has also been shown to be effective in treating P. multocida cellulitis and bacteremia, particularly in cases where first-line antibiotics cannot be used 4.
• For P. multocida bacteremia due to line infection or in the presence of long-term central venous access, treatment with intravenous antibiotics such as ceftazidime and gentamicin line-locks for 2 weeks may be effective 6.

Duration of Treatment

• The duration of treatment for P. multocida bacteremia can vary depending on the severity of the infection and the patient's response to treatment.
• A treatment duration of 14 days has been reported to be effective in some cases 4, 6.
• However, the optimal duration of treatment has not been well established and may require further study.