From the Guidelines
Antibiotics effective against Pseudomonas aeruginosa include novel β-lactam agents such as ceftolozane/tazobactam and ceftazidime/avibactam, which are currently the first-line options for targeted treatment, as recommended by the most recent guidelines 1.
Recommended Treatment Options
The following antibiotics are recommended for the treatment of Pseudomonas aeruginosa infections:
- Antipseudomonal penicillins (piperacillin-tazobactam)
- Carbapenems (meropenem, imipenem)
- Cephalosporins (ceftazidime, cefepime)
- Fluoroquinolones (ciprofloxacin, levofloxacin)
- Aminoglycosides (gentamicin, tobramycin, amikacin)
- Polymyxins (colistin)
Combination Therapy
For serious Pseudomonas infections, combination therapy is often recommended initially, typically using an antipseudomonal beta-lactam (like piperacillin-tazobactam 4.5g IV every 6 hours or cefepime 2g IV every 8 hours) plus either an aminoglycoside or fluoroquinolone, as suggested by 1 and 1.
Treatment Duration
Treatment duration typically ranges from 5-14 days depending on infection site and severity, as recommended by 1.
Considerations
Pseudomonas has intrinsic resistance to many antibiotics due to its impermeable outer membrane, efflux pumps, and ability to produce beta-lactamases, making it challenging to treat. Local antibiogram data should guide therapy choices as resistance patterns vary geographically, and dosing adjustments are necessary for patients with renal impairment. Therapeutic drug monitoring is recommended when using aminoglycosides to minimize toxicity while ensuring efficacy, as noted in 1 and 1.
From the FDA Drug Label
Aerobic bacteria Gram-negative bacteria Pseudomonas aeruginosa
Aerobic bacteria Gram-positive bacteria Enterococcus faecalis Staphylococcus aureus (methicillin-susceptible isolates) Staphylococcus epidermidis (methicillin-susceptible isolates) Staphylococcus saprophyticus Streptococcus pneumoniae (including multi-drug resistant isolates [MDRSP] ) Streptococcus pyogenes Gram-Negative Bacteria Enterobacter cloacae Escherichia coli Haemophilus influenzae Haemophilus parainfluenzae Klebsiella pneumoniae Legionella pneumophila Moraxella catarrhalis Proteus mirabilis Pseudomonas aeruginosa Serratia marcescens
The antibiotics that provide coverage for Pseudomonas (Pseudomonas aeruginosa) infections are:
From the Research
Antibiotics for Pseudomonas aeruginosa Infections
The following antibiotics have been found to provide coverage for Pseudomonas aeruginosa infections:
- Amikacin and imipenem, which remained effective against isolates resistant to one agent 4
- Piperacillin, ceftazidime, or imipenem in combination with amikacin, which were found to be effective combination regimens against most clinical isolates of P. aeruginosa 4
- Ceftazidime, carbapenems, and piperacillin-tazobactam, which were compared as single definitive therapy for P. aeruginosa bloodstream infection, with no significant difference in mortality, clinical, and microbiological outcomes or adverse events demonstrated between them 5
- Cefepime, piperacillin/tazobactam, gentamicin, ciprofloxacin, and levofloxacin, which were evaluated for their synergistic activities against P. aeruginosa, with all combinations found to be bactericidal 6
- Ceftolozane-tazobactam and ceftazidime-avibactam, which have been found to have targeted clinical activity against a significant proportion of P. aeruginosa strains with limited treatment options 7
- Cefiderocol, which has excellent in vitro activity against P. aeruginosa isolates, good stability to all β-lactamases, and against porin and efflux pumps mutations 7
Combination Regimens
Combination regimens that have been found to be effective against P. aeruginosa include:
- Piperacillin, ceftazidime, or imipenem in combination with amikacin 4
- Cefepime or piperacillin/tazobactam in combination with gentamicin, ciprofloxacin, or levofloxacin 6
- Ceftazidime, carbapenems, or piperacillin-tazobactam as single definitive therapy, with no significant difference in outcomes demonstrated between them 5
Resistance Patterns
Resistance patterns to P. aeruginosa have been found to vary by region and over time, with trends toward slightly decreased susceptibility noted in all regions over the last decade, except in Latin America 8. The use of carbapenems has been associated with higher rates of resistant P. aeruginosa 5.