What are the recommended antibiotics (abx) for Pseudomonas urinary tract infection (UTI)?

From the Guidelines

For a Pseudomonas urinary tract infection, the recommended antibiotic is Amikacin, 15 mg/kg IV once daily, due to its effectiveness as an aminoglycoside monotherapy, which is specifically indicated for urinary tract infections, as stated in the guidelines 1. When considering treatment options for Pseudomonas UTI, it's crucial to prioritize the most effective antibiotics that target this specific type of infection.

• The guidelines recommend Amikacin as a monotherapy option for urinary tract infections due to its efficacy against Pseudomonas aeruginosa 1.
• Other treatment options, such as Piperacillin/tazobactam, Ceftazidime, Cefepime, and Ciprofloxacin, are also recommended for various clinical syndromes due to carbapenem-resistant Pseudomonas aeruginosa (CRPA) and difficult-to-treat P.aeruginosa (DTR-PA) 1.
• However, for urinary tract infections specifically, Amikacin is the preferred choice due to its indication as an aminoglycoside monotherapy 1.
• The treatment duration for complicated urinary tract infections is suggested to be 5-10 days, and the definitive treatment duration should be individualized according to infection sites, source control, underlying comorbidities, and the initial response to therapy 1.

From the FDA Drug Label

1. 10 Complicated Urinary Tract Infections: 10 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa [see Clinical Studies (14.8)]. The recommended antibiotic for Pseudomonas UTI is levofloxacin. However, it is essential to note that the drug label recommends combination therapy with an anti-pseudomonal β-lactam when Pseudomonas aeruginosa is a documented or presumptive pathogen 2.

• Key points:
  • Levofloxacin is indicated for complicated urinary tract infections due to Pseudomonas aeruginosa.
  • Combination therapy with an anti-pseudomonal β-lactam is recommended when Pseudomonas aeruginosa is a documented or presumptive pathogen.

From the Research

Recommended Antibiotics for Pseudomonas UTI

• The recommended treatment options for UTIs caused by multidrug-resistant (MDR)-Pseudomonas spp. include:
  • Fluoroquinolones 3
  • Ceftazidime 3
  • Cefepime 3
  • Piperacillin-tazobactam 3
  • Carbapenems, including imipenem-cilastatin/relebactam and meropenem 3
  • Fosfomycin 3
  • Ceftolozane-tazobactam 3
  • Ceftazidime-avibactam 3
  • Aminoglycosides, including plazomicin 3
  • Aztreonam and ceftazidime-avibactam 3
  • Cefiderocol 3
  • Colistin 3
• Ciprofloxacin has been shown to be effective in treating Pseudomonas aeruginosa urinary tract infections, with a cure rate of 64% at one month follow-up 4
• The efficacy of ciprofloxacin in treating chronic Pseudomonas aeruginosa urinary tract infection has been assessed, with a bacteriological cure rate of 44% during the 8-week follow-up period 5
• Oral treatment with ciprofloxacin has been shown to be effective in treating Pseudomonas-induced urinary tract infections, with complete clinical resolution in 8 out of 11 patients 6
• Novel antibiotics, such as cefiderocol, have shown promising results against Pseudomonas aeruginosa, and may be considered for treatment in the future 7