From the Research
Treatment for tracheitis with Stenotrophomonas maltophilia and Serratia marcescens should prioritize combination antibiotic therapy, with trimethoprim-sulfamethoxazole (TMP-SMX) and a carbapenem such as meropenem being potential options, as suggested by the most recent study 1. The choice of antibiotics should be guided by susceptibility testing, considering the intrinsic multidrug resistance of S. maltophilia and the potential for inducible beta-lactamases in S. marcescens.
- Key considerations include:
- TMP-SMX as the first-line therapy for S. maltophilia infections, despite concerns about resistance and the need for combination therapy 1.
- Alternative options for S. maltophilia, such as levofloxacin, minocycline, or ceftazidime, may be considered in cases of resistance or intolerance 2, 3.
- S. marcescens may respond to ciprofloxacin or cefepime, but treatment should be tailored based on susceptibility testing 4, 2.
- Novel therapeutic options, such as cefiderocol or ceftazidime-avibactam plus aztreonam, may offer promising alternatives, although more data are needed to optimize their use 1.
- Supportive care, including adequate hydration, airway management, and possibly corticosteroids to reduce inflammation, is essential for optimizing outcomes.
- Obtaining cultures with susceptibility testing before initiating antibiotics is crucial for guiding therapy and minimizing the risk of treatment failure or the development of further resistance 1.