Treatment of Pasteurella multocida Bacteremia
Penicillin G is the first-line treatment for Pasteurella multocida bacteremia, administered at a dose of 4-6 million units per day intravenously for 2 weeks. 1
First-Line Treatment Options
Intravenous Therapy
- Penicillin G: 4-6 million units/day divided every 4-6 hours for 2 weeks 1
- FDA-approved specifically for Pasteurella infections including bacteremia and meningitis
- Highly effective against P. multocida with excellent clinical outcomes
Alternative Options (for penicillin-allergic patients)
- Fluoroquinolones: Ciprofloxacin has shown efficacy in treating P. multocida bacteremia 2
- Doxycycline: Highly effective alternative for P. multocida infections 3
- Amoxicillin-clavulanate: Effective combination therapy that covers P. multocida 4
Treatment Duration and Monitoring
- Standard treatment duration: 2 weeks for uncomplicated bacteremia 1
- Longer treatment (4-6 weeks) may be necessary if there is evidence of:
- Endocarditis
- Osteomyelitis
- Other metastatic infections
Special Considerations
Immunocompromised Patients
- More aggressive treatment may be warranted in immunocompromised patients 2
- Consider combination therapy in severely ill or immunocompromised patients
- Blood cultures should be repeated to ensure clearance of bacteremia
Renal Impairment
- For patients with severe renal impairment (creatinine clearance <10 mL/min):
- Administer full loading dose of penicillin G
- Follow with one-half the loading dose every 8-10 hours 1
Source Control
- Identify and address the source of infection
- Most common sources include:
- Wound debridement may be necessary if there is evidence of necrotizing infection
Clinical Pearls
- P. multocida bacteremia has a high mortality rate if not treated promptly 2
- The infection typically develops rapidly after animal exposure 6
- Patients with diabetes mellitus and chronic kidney disease are at higher risk for severe infections 2
- Always obtain a thorough history of animal exposure in patients with suspected bacteremia
Common Pitfalls
- Failing to consider P. multocida in patients with recent animal exposure
- Delaying appropriate antibiotic therapy
- Using antibiotics with poor activity against P. multocida (such as first-generation cephalosporins or macrolides alone)
- Not addressing the source of infection
Early recognition and prompt initiation of appropriate antibiotic therapy are crucial for successful treatment of P. multocida bacteremia, particularly in immunocompromised patients.