What cephalosporins (a class of beta-lactam antibiotics) are effective against Pseudomonas (a type of bacteria) infections?

From the Guidelines

Ceftolozane/tazobactam and ceftazidime/avibactam are the recommended cephalosporins for treating Pseudomonas aeruginosa infections, particularly in cases with difficult-to-treat resistance. These antipseudomonal cephalosporins are typically administered intravenously, with ceftolozane/tazobactam given at 1.5g every 8 hours and ceftazidime/avibactam at 2.5g every 8 hours, with dosage adjustments needed for patients with renal impairment. Treatment duration generally ranges from 5-14 days depending on infection severity and site, as suggested by 1 and 1. Key considerations include:

• Susceptibility testing to guide therapy, as Pseudomonas can develop resistance
• Potential use in combination with other antibiotic classes like aminoglycosides or fluoroquinolones for severe infections to prevent resistance development and provide synergistic effects
• Importance of monitoring for signs of resistance and adjusting treatment accordingly, as highlighted in 1 and 1. It's also worth noting that other cephalosporins such as cefepime may be effective against Pseudomonas aeruginosa, but the most recent and highest quality evidence supports the use of ceftolozane/tazobactam and ceftazidime/avibactam, as stated in 1 and 1.

From the FDA Drug Label

FORTAZ is indicated for the treatment of patients with infections caused by susceptible strains of the designated organisms in the following diseases:

1. Lower Respiratory Tract Infections, including pneumonia, caused by Pseudomonas aeruginosa and other Pseudomonas spp.
2. Skin and Skin-Structure Infections caused by Pseudomonas aeruginosa
3. Urinary Tract Infections, both complicated and uncomplicated, caused by Pseudomonas aeruginosa
4. Bacterial Septicemia caused by Pseudomonas aeruginosa
5. Bone and Joint Infections caused by Pseudomonas aeruginosa
6. Central Nervous System Infections, including meningitis, caused by ... Pseudomonas aeruginosa

Ceftazidime is a cephalosporin effective against Pseudomonas infections, including:

• Lower Respiratory Tract Infections
• Skin and Skin-Structure Infections
• Urinary Tract Infections
• Bacterial Septicemia
• Bone and Joint Infections
• Central Nervous System Infections, including meningitis 2

From the Research

Cephalosporins Effective Against Pseudomonas Infections

• Cefepime, a fourth-generation cephalosporin, is effective against Pseudomonas aeruginosa infections 3, 4, 5.
• Ceftazidime, a third-generation cephalosporin, is also effective against Pseudomonas aeruginosa infections 6, 7.
• Cefsulodin, a second-generation cephalosporin, has narrow-spectrum activity against Pseudomonas aeruginosa, but its use is limited due to its narrow spectrum of activity 6.

Pharmacokinetics and Pharmacodynamics

• Cefepime exhibits linear pharmacokinetic behavior, with a half-life of approximately 2-2.5 hours in patients with normal renal function 4.
• Ceftazidime has a broad spectrum of activity and is stable against beta-lactamases, making it effective against Pseudomonas aeruginosa infections 6.
• The pharmacodynamic target for cefepime is to maintain serum levels above the MIC for 60-70% of the dosing interval, which can be achieved with 2g doses every 12 hours 5.

Clinical Use

• Cefepime and ceftazidime are both effective as single agents for the treatment of Pseudomonas aeruginosa infections, including bacteremia 7.
• Ceftazidime may be preferred over carbapenems due to its ability to spare carbapenem use and reduce the risk of resistance development 7.
• Cefepime and ceftazidime have been used successfully in various clinical settings, including lower respiratory tract, intra-abdominal, and urinary tract infections 4, 5.