What antibiotics are effective against Pseudomonas (Pseudomonas aeruginosa) urinary tract infections (UTIs)?

From the Guidelines

For treating pseudomonas urinary tract infections (UTIs), the recommended antibiotics include ciprofloxacin or levofloxacin, with a preferred dose of levofloxacin being 750mg orally once daily, in combination with an antipneumococcal, antipseudomonal beta-lactam such as piperacillin-tazobactam, cefepime, imipenem, or meropenem 1. When considering treatment options, it's essential to take into account the severity of the infection and the potential for antibiotic resistance.

• For more severe infections, combination therapy with an antipseudomonal beta-lactam plus an aminoglycoside and azithromycin or an antipneumococcal fluoroquinolone may be necessary 1.
• Culture and sensitivity testing is crucial before starting treatment to ensure the selected antibiotic will be effective, as Pseudomonas aeruginosa is naturally resistant to many antibiotics due to its impermeable outer membrane, efflux pumps, and ability to produce beta-lactamases.
• Patients should complete the full course of antibiotics even if symptoms improve, drink plenty of fluids, and follow up with their healthcare provider to confirm the infection has cleared completely. The most recent and highest quality study, although from 2009, still provides the best guidance for treating pseudomonas UTIs, emphasizing the importance of using antipneumococcal, antipseudomonal beta-lactams in combination with other antibiotics for optimal outcomes 1.

From the FDA Drug Label

Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa [see Clinical Studies (14.8)]. Levofloxacin is an antibiotic that can treat Pseudomonas UTI, specifically complicated urinary tract infections caused by Pseudomonas aeruginosa 2.

From the Research

Treatment Options for Pseudomonas UTI

• The treatment options for UTIs caused by multidrug resistant (MDR)-Pseudomonas spp. include:
  • Fluoroquinolones 3
  • Ceftazidime 3, 4
  • Cefepime 3, 5
  • Piperacillin-tazobactam 3, 4, 5
  • Carbapenems including imipenem-cilastatin/relebactam, meropenem 3, 4
  • Fosfomycin 3
  • Ceftolozane-tazobactam 3
  • Ceftazidime-avibactam 3
  • Aminoglycosides including plazomicin 3
  • Aztreonam 3, 5
  • Cefiderocol 3
  • Colistin 3

Efficacy of Ciprofloxacin

• Ciprofloxacin has been shown to be effective in treating Pseudomonas aeruginosa infections, including UTIs 6, 7
• However, the development of resistance to ciprofloxacin is a concern 6, 7

Comparison of Antibiotics

• A study compared ceftazidime, carbapenems, and piperacillin-tazobactam as definitive monotherapy for Pseudomonas aeruginosa bacteremia and found no significant difference in mortality, clinical, and microbiological outcomes or adverse events between the three antibiotics 4
• Another study found that the combination of a beta-lactam with an aminoglycoside or a fluoroquinolone was effective against Pseudomonas aeruginosa, with no significant difference in synergistic activity between the different combinations 5