From the Guidelines
For incisional infections with Pseudomonas, the best antibiotic choices include Piperacillin/tazobactam 3.375-4.5 g IV every 6 hours, Ceftazidime 2 g IV every 8 hours, Cefepime 2 g IV every 8-12 hours, or Ciprofloxacin 400 mg IV every 8 hours, with a treatment duration of 5-14 days, depending on the severity of the infection and clinical response. When considering treatment options for incisional infections with Pseudomonas, it's essential to take into account the susceptibility testing results from the positive culture, as Pseudomonas frequently develops resistance 1. Some key points to consider when selecting an antibiotic regimen include:
- The use of anti-pseudomonal penicillins or cephalosporins combined with aminoglycosides may be considered when the antimicrobial susceptibility testing results are interpreted as susceptible 1.
- Aminoglycoside monotherapy is only indicated for urinary tract infections 1.
- The suggested treatment duration is 5-10 days for complicated urinary tract infection and complicated intra-abdominal infection, while a treatment course of 10-14 days is suggested for hospital-acquired or ventilator-associated pneumonia and bloodstream infection 1.
- Definitive treatment durations should be individualized according to infection sites, source control, the underlying comorbidities, and the initial response to therapy 1.
- Local wound care with regular cleaning and debridement is also essential for successful treatment. It's crucial to note that Pseudomonas is particularly challenging to treat because of its intrinsic resistance mechanisms, including low outer membrane permeability, efflux pumps, and production of beta-lactamases, which is why targeted therapy based on susceptibility testing is crucial for effective management 1.
From the FDA Drug Label
Adult Patients: Skin and Skin Structure Infections caused by ... Pseudomonas aeruginosa, The clinical efficacy rates by pathogen are provided in Table 8 Pseudomonas aeruginosa 11/15 (73)
The best antibiotic choices for an incisional infection with a positive culture for Pseudomonas are:
- Meropenem 2
- Ciprofloxacin 3 Key points:
- Meropenem has a clinical efficacy rate of 73% against Pseudomonas aeruginosa.
- Ciprofloxacin is effective against Pseudomonas aeruginosa in skin and skin structure infections.
From the Research
Antibiotic Choices for Incisional Infection with Pseudomonas
- The best antibiotic choices for an incisional infection with a positive culture for Pseudomonas include:
- A beta-lactam plus an aminoglycoside, which is the standard for treating severe Pseudomonas aeruginosa infections 4
- Fluoroquinolones, such as ciprofloxacin or levofloxacin, which are safer and have been widely used as an alternative to aminoglycosides 4
- Novel antibiotics, such as cefiderocol, which shows promising results against Pseudomonas aeruginosa 5
- Carbapenems, such as meropenem, which has a broad spectrum of in vitro activity against Gram-positive and Gram-negative pathogens, including Pseudomonas aeruginosa 6
Combination Therapy
- Combination therapy with a beta-lactam and a fluoroquinolone, such as cefepime and ciprofloxacin, has been shown to be effective against Pseudomonas aeruginosa 4, 7
- Combination therapy with a beta-lactam and an aminoglycoside, such as ceftazidime and gentamicin, has also been shown to be effective 4
- However, the choice of combination therapy should be guided by the epidemiology, patient's risk factors, site of infection, and available treatment options 5
Single Definitive Therapy
- Ceftazidime, carbapenems, and piperacillin-tazobactam have been shown to be effective as single definitive therapy for Pseudomonas aeruginosa bloodstream infection 8
- However, the choice of single definitive therapy should be guided by the susceptibility of the isolate and the patient's clinical condition 8