What oral antibiotics, specifically oral cephalosporins (cephs), have coverage for Pseudomonas?

Oral Cephalosporins with Pseudomonas Coverage

No oral cephalosporins have reliable activity against Pseudomonas aeruginosa. For Pseudomonas infections requiring oral therapy, ciprofloxacin is the most reliable oral option 1.

Available Antipseudomonal Antibiotics

Intravenous Cephalosporins with Pseudomonas Activity

• Ceftazidime (2g IV q8h) - considered one of the most active cephalosporins against P. aeruginosa 2, 3
• Cefepime (2g IV q8-12h) - has good activity against P. aeruginosa 2, 4

Other IV Antipseudomonal Options

• Piperacillin-tazobactam (3.375-4.5g IV q6h) - preferred first-line agent for susceptible P. aeruginosa 2, 5
• Carbapenems (except ertapenem) - imipenem, meropenem, and doripenem have activity against P. aeruginosa 2
• Aztreonam (2g IV q8h) - monobactam with antipseudomonal activity, useful in patients with β-lactam allergies 1, 2
• Aminoglycosides - amikacin, gentamicin, and tobramycin have activity against P. aeruginosa but require drug level monitoring 2, 6

Oral Antipseudomonal Options

• Ciprofloxacin - the most reliable oral option for P. aeruginosa infections 1, 2
• Levofloxacin (750mg) - has some activity against P. aeruginosa but generally less potent than ciprofloxacin 2

Clinical Considerations

For Cystic Fibrosis Patients

• Ciprofloxacin has been used successfully in CF patients with P. aeruginosa infections 1
• Oral ciprofloxacin therapy has been shown to prolong the beneficial effects of intravenous antibiotic therapy 1
• Rapid emergence of resistance can be a significant problem with fluoroquinolone monotherapy 1

For Hospital-Acquired Pneumonia

• For patients with risk factors for P. aeruginosa, recommended IV options include:
  • Piperacillin-tazobactam, cefepime, ceftazidime, imipenem, or meropenem 1
  • For severe cases, combination therapy may be warranted 1

For Multidrug-Resistant P. aeruginosa

• Combination therapy is often recommended for difficult-to-treat resistant strains 2, 7
• Recommended combinations include:
  • Antipseudomonal β-lactam + ciprofloxacin or levofloxacin 2
  • Antipseudomonal β-lactam + aminoglycoside 2, 7

Important Caveats

• Ertapenem lacks reliable antipseudomonal activity, unlike other carbapenems 2
• Risk factors for multidrug-resistant P. aeruginosa include prior intravenous antibiotic use within 90 days, prolonged hospitalization, and septic shock 2
• For patients who have received recent antibiotic therapy, consider using an alternative class of antibiotics to prevent resistance development 2
• Aminoglycoside monotherapy should only be considered for uncomplicated urinary tract infections 2

In conclusion, while there are several effective intravenous options for treating Pseudomonas infections, there are no oral cephalosporins with reliable activity against P. aeruginosa. Ciprofloxacin remains the most reliable oral option for Pseudomonas infections.