What alternative medication to penicillin (Penicillin) is recommended to treat Pasteurella multocida bacteremia in patients with a penicillin allergy?

From the Guidelines

For Pasteurella multocida bacteremia in patients with penicillin allergy, doxycycline (100 mg orally twice daily) or a fluoroquinolone such as ciprofloxacin (400 mg IV twice daily or 500-750 mg orally twice daily) is recommended for 10-14 days. This recommendation is based on the guidelines for the diagnosis and management of skin and soft-tissue infections, which suggest that patients with previous severe reactions can receive oral or intravenous doxycycline, trimethoprim-sulfamethoxazole, or a fluoroquinolone plus clindamycin 1.

Key Considerations

• The choice between these options depends on the severity of the infection, patient factors, and local resistance patterns.
• For severe infections, initial IV therapy followed by oral step-down therapy is appropriate.
• In cases of serious penicillin allergy, carbapenems should be avoided due to potential cross-reactivity.
• Pasteurella multocida is typically susceptible to these alternative antibiotics, though fluoroquinolones may have slightly lower efficacy compared to beta-lactams.

Treatment Duration and Monitoring

• Treatment duration may need extension if there are complications such as endocarditis or osteomyelitis.
• Clinical improvement should be evident within 48-72 hours of appropriate therapy, and follow-up blood cultures may be necessary to confirm clearance of bacteremia.
• Trimethoprim-sulfamethoxazole (TMP-SMX) is another alternative (5 mg/kg of the trimethoprim component IV or orally twice daily) 1.

From the Research

Treatment Options for Pasteurella Multicida Bacteremia

• For patients with penicillin allergy, alternative treatment options include:
  • Aztreonam 2
  • Levofloxacin 3
  • Cefprozil, cefuroxime, trimethoprim/sulfamethoxazole, ciprofloxacin, and tetracycline 4
  • Ceftazidime and gentamicin line-locks 5
• The duration of treatment for Pasteurella multicida bacteremia is:
  • 14 days with aztreonam 2
  • 2 weeks with intravenous ceftazidime and gentamicin line-locks 5

Considerations for Penicillin Allergy

• Patients with penicillin allergy may be treated with alternative antibiotics, such as those listed above
• The choice of antibiotic should be based on the severity of the infection and the patient's medical history

Antibiotic Susceptibility

• Pasteurella multocida isolates are generally susceptible to most widely used antimicrobial agents 6
• However, resistance to sulphonamides, tetracyclines, first-generation quinolones, and aminoglycosides has been reported 6