From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Achromobacter xylosoxidans infections should be treated with piperacillin-tazobactam or ceftazidime-avibactam as the primary option, given their high susceptibility rates of 70% and 62%, respectively, as reported in the most recent study 1. The treatment of Achromobacter xylosoxidans infections is challenging due to the organism's intrinsic resistance to many antibiotics.
- The recommended treatment usually involves a combination of antibiotics, with piperacillin-tazobactam (4.5g IV every 6-8 hours) being a viable option, particularly for respiratory infections, as it has shown a high susceptibility rate of 70% 1.
- Ceftazidime-avibactam is another option, with a susceptibility rate of 62% 1, and can be used for severe infections.
- For less severe infections, trimethoprim-sulfamethoxazole (TMP-SMX) at a dose of 5mg/kg of the trimethoprim component every 12 hours may be effective, although its susceptibility rate is lower, ranging from 30% to 49% 1, 2.
- Treatment duration typically ranges from 7-14 days for mild to moderate infections and may extend to 2-6 weeks for severe or complicated infections such as bacteremia or endocarditis.
- Antibiotic susceptibility testing is crucial as resistance patterns vary, and therapy should be adjusted based on these results 1, 2.
- In cases involving biofilm formation, such as in cystic fibrosis patients or those with indwelling devices, higher doses and longer treatment durations may be necessary, and removal of infected devices is often required for successful treatment 3. Key considerations in the treatment of Achromobacter xylosoxidans infections include:
- The use of combination antibiotic therapy to overcome the organism's intrinsic resistance
- The importance of antibiotic susceptibility testing to guide treatment decisions
- The need for prolonged treatment durations and higher doses in cases involving biofilm formation or complicated infections
- The potential for microbiologic relapse, even with effective treatment, as observed in a study using cefiderocol 3.