What is the treatment for nasal Pluralibacter gergoviae infection?

Treatment of Nasal Pluralibacter gergoviae Infection

Amoxicillin-clavulanate is the first-line treatment for nasal Pluralibacter gergoviae infection due to its broad spectrum of activity against respiratory pathogens including Enterobacteriaceae family members. 1

First-Line Treatment Options

• Amoxicillin-clavulanate should be administered for 7-10 days as the preferred first-line therapy for nasal P. gergoviae infection 1
• Standard adult dosing is typically 875/125 mg twice daily for the treatment course 1
• For children, appropriate weight-based dosing of amoxicillin-clavulanate should be used with adequate potassium clavulanate levels to inhibit β-lactamase–producing organisms 2

Alternative Treatment Options (for Penicillin Allergy)

• Second-generation cephalosporins such as cefuroxime-axetil are recommended alternatives for patients with penicillin allergy 3, 1
• Third-generation cephalosporins such as cefpodoxime-proxetil or cefotiam-hexetil are also effective alternative options 3, 1
• Pristinamycin is recommended particularly in cases of beta-lactam allergy 3

Treatment Duration

• Standard duration of treatment is 7-10 days for most cases 3, 1
• Cefuroxime-axetil and cefpodoxime-proxetil have demonstrated efficacy with shorter 5-day regimens 3, 1
• For more severe infections, longer courses may be necessary 1

Management of Treatment Failures or Resistant Strains

• If no clinical improvement after 72 hours of initial therapy, consider switching to respiratory fluoroquinolones (levofloxacin or moxifloxacin) 1
• Fluoroquinolones should be reserved for situations where major complications are likely, such as frontal, fronto-ethmoidal or sphenoidal sinusitis, or after failure of first-line therapy 3
• For severe infections or confirmed resistant strains, consider parenteral therapy with ceftriaxone 1 g/day IM or IV 1
• P. gergoviae can develop multidrug resistance, including to carbapenems, so susceptibility testing is crucial in treatment failures 4

Adjunctive Therapies

• Intranasal saline irrigation may help alleviate symptoms and improve medication delivery 5
• Intranasal corticosteroids may provide symptomatic relief, especially in cases with significant inflammation 3
• Short-term decongestants may be beneficial for nasal congestion but should not be used for more than 3 days to avoid rebound congestion 5

Monitoring and Follow-up

• Clinical improvement should be expected within 72 hours of appropriate antibiotic therapy 1
• If symptoms persist or worsen after 72 hours, consider:
  • Changing antibiotic therapy based on likely resistance patterns 1
  • Obtaining cultures if not previously done 1
  • Evaluating for complications or alternative diagnoses 1

Decolonization for Recurrent Infections

• For recurrent nasal infections, consider a decolonization regimen with mupirocin 2% ointment applied twice daily for 5-10 days 1
• Environmental cleaning of high-touch surfaces is recommended to prevent reinfection 1

Special Considerations

• P. gergoviae can exhibit high levels of multidrug resistance, including production of KPC carbapenemases, which significantly limits treatment options 4
• In severe cases, combination therapy may be necessary based on susceptibility testing 4
• The clinical approach should be more aggressive in immunocompromised patients or those with anatomic abnormalities of the sinuses 6