Recommended Treatment for Proteus Coverage
For Proteus species coverage, the recommended first-line treatment is an anti-pseudomonal β-lactam such as cefepime, a carbapenem (imipenem-cilastatin or meropenem), or piperacillin-tazobactam as monotherapy. 1
Treatment Algorithm Based on Clinical Context
Community-Acquired Infections (Mild to Moderate)
- First-line options:
- Ampicillin-sulbactam
- Cefazolin or cefuroxime plus metronidazole
- Ticarcillin-clavulanate
- Ertapenem
- Fluoroquinolones (ciprofloxacin or levofloxacin) plus metronidazole 1
Nosocomial or Healthcare-Associated Infections
- First-line options:
- Meropenem or imipenem-cilastatin
- Piperacillin-tazobactam
- Cefepime
- Third or fourth-generation cephalosporin plus metronidazole 1
For Documented Proteus Infections
- Based on susceptibility testing:
Special Considerations
Carbapenem-Sparing Approach
- In settings with high incidence of carbapenem-resistant organisms, consider:
- Ceftolozane/tazobactam plus metronidazole
- β-lactam/β-lactamase inhibitor combinations 1
For Specific Clinical Scenarios
Skin and Soft Tissue Infections with Proteus
- For uncomplicated infections: Levofloxacin 3
- For complicated infections requiring broader coverage: Vancomycin plus anti-pseudomonal β-lactam 1
Intra-abdominal Infections with Proteus
- Monotherapy with broad-spectrum antimicrobials has advantages including reduced toxicity and drug interactions 1
- Consider local resistance patterns when selecting therapy 1
Emerging Resistance Concerns
Recent data shows increasing antibiotic resistance in Proteus species, with resistance rates rising from 48.4% in 2011 to 74% in 2020 6. This highlights the importance of:
- Obtaining cultures and susceptibility testing
- De-escalating therapy once susceptibilities are known
- Using combination therapy for severe infections when resistance is suspected
Common Pitfalls to Avoid
- Underestimating resistance: Proteus species are increasingly showing resistance to multiple antibiotics 6
- Overusing carbapenems: Reserve for severe infections or known resistant organisms 1
- Inadequate dosing: Higher doses may be needed for serious infections 1
- Failure to adjust therapy: Once culture results are available, narrow therapy based on susceptibilities 1
The choice of antimicrobial therapy must take into consideration local resistance patterns, patient-specific factors, and the site of infection. Regular monitoring of clinical response and adjustment of therapy based on culture results is essential for optimal outcomes.