From the Guidelines
Intravenous treatment with piperacillin-tazobactam (3.375-4.5 g IV every 6 hours) or ceftazidime (2 g IV every 8 hours) is recommended for pseudomonas infections, with treatment duration ranging from 5-14 days depending on the infection site and severity. When considering the treatment of pseudomonas infections, it is essential to take into account the severity of the infection and the susceptibility of the organism to various antibiotics 1. The choice of antibiotic should be guided by antimicrobial susceptibility testing results, and combination therapy may be considered for severe infections or resistant strains 1. Some key points to consider when treating pseudomonas infections include:
- The use of antipseudomonal beta-lactams, such as piperacillin-tazobactam or ceftazidime, as first-line IV options 1
- The potential need for combination therapy, including the addition of an aminoglycoside or a fluoroquinolone, for severe infections or resistant strains 1
- The importance of obtaining cultures and susceptibility testing to guide definitive therapy 1
- The need for dosing adjustments in patients with renal impairment and regular monitoring of renal function, especially when using aminoglycosides 1
- The recommended treatment duration, which generally ranges from 5-14 days depending on the infection site and severity, with longer courses needed for complicated infections 1.
From the FDA Drug Label
For Pseudomonas aeruginosa, use 2 g IV every 8 hours (50 mg per kg per dose in pediatric patients 2 months up to 16 years) Nosocomial Pneumonia Piperacillin and Tazobactam for Injection is indicated in adults and pediatric patients (2 months of age and older) for the treatment of nosocomial pneumonia (moderate to severe) caused by beta-lactamase producing isolates of ... Pseudomonas aeruginosa (Nosocomial pneumonia caused by P. aeruginosa should be treated in combination with an aminoglycoside)
IV treatment antibiotic for pseudomonas:
- Cefepime: 2 g IV every 8 hours 2
- Piperacillin-tazobactam: 4.5 grams every six hours plus an aminoglycoside for nosocomial pneumonia caused by P. aeruginosa 3
From the Research
IV Treatment Antibiotic for Pseudomonas
- Piperacillin-tazobactam is frequently used to treat Pseudomonas aeruginosa infections in critically ill patients 4.
- Extended-infusion piperacillin-tazobactam therapy is a suitable alternative to intermittent-infusion piperacillin-tazobactam therapy, and may improve outcomes for critically ill patients with P. aeruginosa infection 4.
- A systematic review and meta-analysis found no evidence of clinical benefit differences among direct antibiotic comparisons for P. aeruginosa infection, but all subgroup analyses were underpowered to detect significant differences 5.
- Ceftazidime, carbapenems, and piperacillin-tazobactam as single definitive therapy for Pseudomonas aeruginosa bloodstream infection showed no significant difference in mortality, clinical, and microbiological outcomes or adverse events 6.
- Prolonged- and continuous-infusion strategies of piperacillin-tazobactam improved the pharmacodynamics over traditional 30-minute intermittent-infusion regimens 7.
- Evidence-based treatment of Pseudomonas aeruginosa infections recommends ceftolozane-tazobactam or ceftazidime-avibactam as empirical treatment, and antibiotic de-escalation after antimicrobial susceptibility tests 8.
Antibiotic Options
- Piperacillin-tazobactam: effective against P. aeruginosa, with improved outcomes with extended-infusion therapy 4, 7.
- Ceftazidime: no significant difference in mortality, clinical, and microbiological outcomes compared to carbapenems and piperacillin-tazobactam 6.
- Carbapenems: higher rates of resistant P. aeruginosa after treatment, and higher clinical failure rates compared to piperacillin-tazobactam 5, 6.
- Ceftolozane-tazobactam and ceftazidime-avibactam: recommended as empirical treatment for suspected P. aeruginosa infections 8.