From the Guidelines
Ciprofloxacin is the best oral antibiotic for Pseudomonas cellulitis, typically dosed at 750 mg twice daily for 7-14 days depending on severity. This recommendation is based on the guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents, which suggest using an antipneumococcal, antipseudomonal beta-lactam plus either ciprofloxacin or levofloxacin (750 mg dose) if risk factors for Pseudomonas infection are present 1.
Key Considerations
- Before starting treatment, obtaining cultures when possible is important as Pseudomonas is inherently resistant to many standard antibiotics used for typical cellulitis.
- Patients should be monitored closely as Pseudomonas infections can progress rapidly, and some cases may require initial intravenous therapy before transitioning to oral antibiotics.
- Fluoroquinolones, such as ciprofloxacin, are preferred because they achieve good tissue penetration and have reliable activity against Pseudomonas aeruginosa.
- However, resistance is increasing, so susceptibility testing is valuable when available.
Patient Advice
- Patients should be advised to complete the full course of antibiotics even if symptoms improve quickly.
- Staying hydrated and elevating the affected area when possible can help alleviate symptoms.
- Patients should return for evaluation if the infection worsens despite treatment.
Alternative Options
- Levofloxacin (750 mg once daily) is an alternative fluoroquinolone option for treating Pseudomonas cellulitis 1.
From the FDA Drug Label
Skin and Skin Structure Infections caused by Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Proteus mirabilis, Proteus vulgaris, Providencia stuartii, Morganella morganii, Citrobacter freundii, Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus aureus, methicillin-susceptible Staphylococcus epidermidis, or Streptococcus pyogenes Levofloxacin tablets are indicated for the treatment of complicated skin and skin structure infections due to methicillin-susceptible Staphylococcus aureus, Enterococcus faecalis, Streptococcus pyogenes, or Proteus mirabilis Levofloxacin tablets are indicated for the treatment of uncomplicated skin and skin structure infections (mild to moderate) including abscesses, cellulitis, furuncles, impetigo, pyoderma, wound infections, due to methicillin-susceptible Staphylococcus aureus, or Streptococcus pyogenes.
The best oral (PO) antibiotic for cellulitis caused by Pseudomonas is ciprofloxacin or levofloxacin 2 3.
- Key points:
- Ciprofloxacin and levofloxacin are both effective against Pseudomonas aeruginosa.
- They can be used to treat skin and skin structure infections, including cellulitis.
- It is essential to consider local epidemiology and susceptibility patterns when selecting therapy.
- Culture and susceptibility testing should be performed before treatment to ensure the bacteria are susceptible to the chosen antibiotic.
From the Research
Best Oral Antibiotic for Cellulitis Caused by Pseudomonas
- The best oral antibiotic for cellulitis caused by Pseudomonas is likely to be ciprofloxacin, as it has been shown to be effective in treating Pseudomonas aeruginosa infections in several studies 4, 5, 6, 7.
- Ciprofloxacin has been used to treat a variety of infections, including cellulitis, osteomyelitis, and urinary tract infections, and has been shown to have a high clinical response rate and bacteriological cure rate 4, 5, 6, 7.
- Another option could be levofloxacin, which has been shown to have similar activity to ciprofloxacin against Pseudomonas aeruginosa in vitro 8.
- It's worth noting that the development of resistance to ciprofloxacin has been observed in some cases, and the use of this antibiotic should be carefully considered and monitored 5, 7.
- The dosage and duration of treatment with ciprofloxacin or levofloxacin will depend on the specific infection and the patient's condition, and should be determined by a healthcare professional 4, 5, 6, 7.