What antibiotics have pseudomonas coverage for recurrent otitis media?

From the Guidelines

For recurrent otitis media with suspected Pseudomonas aeruginosa involvement, cefepime (2 g IV q8h) is a recommended antibiotic with pseudomonas coverage. When considering antibiotics with pseudomonas coverage, it's essential to choose an option that is effective against this bacterium. According to the guidelines for the treatment of pneumonia in Taiwan 1, several antibiotics have been recommended for pseudomonas coverage, including:

• Piperacillin/tazobactam (4.5 g IV q8h-q6h)
• Ticarcillin/clavulanate (3.1 g IV q6h)
• Cefoperazone/sulbactam (4 g IV q12h)
• Cefepime (2 g IV q8h)
• Imipenem (500 mg IV q6h)
• Meropenem (1 g IV q8h)
• Ciprofloxacin (400 mg IV q8h-e12h)
• Levofloxacin (750 mg IV qd)
• Amikacin (15-20 mg/kg IV qd) However, cefepime (2 g IV q8h) is a suitable choice for pseudomonas coverage in recurrent otitis media, considering its effectiveness and the potential for less resistance compared to other options. It's crucial to note that the treatment should be guided by the severity of the infection, patient's overall health, and potential allergies or interactions with other medications. Additionally, careful cleaning of the ear canal before antibiotic administration and follow-up evaluation are essential to ensure the resolution of the infection and prevent complications.

From the FDA Drug Label

Gentamicin has been shown to be active against most of the following bacteria, both in vitro and in clinical infections ... Gram-Negative Bacteria ... Pseudomonas aeruginosa The combined effect of gentamicin and carbenicillin is synergistic for many strains of Pseudomonas aeruginosa Levofloxacin has in vitro activity against Gram-negative and Gram-positive bacteria ... Gram-Negative Bacteria ... Pseudomonas aeruginosa

Antibiotics with Pseudomonas coverage for recurrent otitis media include:

• Gentamicin (IV) 2
• Levofloxacin (PO) 3 These antibiotics have shown in vitro activity against Pseudomonas aeruginosa. However, it's essential to consider the specific clinical context and potential synergistic effects with other antibiotics, such as the combination of gentamicin and carbenicillin.

From the Research

Antibiotics with Pseudomonas Coverage

For recurrent otitis media, several antibiotics have been found to have pseudomonas coverage. These include:

• Meropenem, as seen in a study from 4, which found that pseudomonas aeruginosa was sensitive to this antibiotic.
• Imipenem, also found to be effective against pseudomonas aeruginosa in studies 4 and 5.
• Ceftazidime, which was shown to be effective in studies 4 and 5.
• Amikacin, found to be effective in studies 4 and 5.
• Piperacillin, also shown to be effective in study 5.
• Ciprofloxacin, which was found to be effective in studies 4, 6, and 7, but has been shown to have increasing resistance in study 5 and 8.
• Levofloxacin, which was found to be effective in studies 4, 6, and 7, but also has shown increasing resistance in study 8.

Considerations for Antibiotic Choice

When choosing an antibiotic for pseudomonas coverage in recurrent otitis media, it is essential to consider the potential for antibiotic resistance, as seen in studies 5 and 8. The choice of antibiotic should be based on the results of bacterial culture and drug sensitivity testing, as recommended in study 4. Additionally, the use of topical antibiotics, such as ciprofloxacin eardrops, may be effective in treating chronic otitis media, as seen in study 7.