From the FDA Drug Label
1.2 Urinary Tract Infections (complicated and uncomplicated) Imipenem and Cilastatin for Injection, USP (I.V.) is indicated for the treatment of urinary tract infections (complicated and uncomplicated) caused by susceptible strains of ... Providencia rettgeri, 1.7 Skin and Skin Structure Infections Imipenem and Cilastatin for Injection, USP (I.V.) is indicated for the treatment of skin and skin structure infections caused by susceptible strains of ... Providencia rettgeri,
The preferred antibiotic treatment for Providencia rettgeri infection is Imipenem and Cilastatin for Injection, USP (I.V.) 1.
- The dosage recommendations are as follows:
- 500 mg every 6 hours
- 1,000 mg every 8 hours
- 1,000 mg every 6 hours for infections suspected or proven to be due to bacterial species with intermediate susceptibility
- The maximum total daily dosage should not exceed 4 g/day.
- Administration should be by intravenous infusion over 20 to 30 minutes for 500 mg, or 40 to 60 minutes for 1,000 mg.
From the Research
Carbapenems, such as imipenem, meropenem, or ertapenem, are generally the preferred antibiotics for treating Providencia rettgeri infections, as supported by the most recent study 2. For severe infections, imipenem 500 mg IV every 6 hours or meropenem 1 gram IV every 8 hours is typically recommended for 7-14 days, depending on the infection site and severity. Providencia rettgeri commonly produces extended-spectrum beta-lactamases (ESBLs) and AmpC beta-lactamases, making it resistant to many antibiotics including penicillins, cephalosporins, and sometimes fluoroquinolones. Some key points to consider when treating Providencia rettgeri infections include:
- Treatment should always be guided by antimicrobial susceptibility testing due to increasing resistance patterns, as highlighted in 3 and 4.
- Alternative options may include aminoglycosides (like amikacin 15 mg/kg IV once daily), fluoroquinolones (such as ciprofloxacin 400 mg IV twice daily), or piperacillin-tazobactam (4.5 g IV every 6 hours) if susceptibility is confirmed.
- For urinary tract infections, which are the most common Providencia infections, oral options may include trimethoprim-sulfamethoxazole or fosfomycin if the isolate is susceptible, as noted in 5 and 6.
- Combination therapy might be necessary for severe or complicated infections to prevent the emergence of resistance during treatment, as suggested by 2. It is essential to prioritize the use of the most recent and highest quality study, which in this case is 2, to guide treatment decisions and minimize morbidity, mortality, and impact on quality of life.