From the FDA Drug Label
Skin and Skin Structure Infections caused by Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Proteus mirabilis, Proteus vulgaris, Providencia stuartii, Morganella morganii, Citrobacter freundii, Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus aureus, methicillin-susceptible Staphylococcus epidermidis, or Streptococcus pyogenes Bone and Joint Infections caused by Enterobacter cloacae, Serratia marcescens, or Pseudomonas aeruginosa
The antibiotic ciprofloxacin can be used to treat cellulitis due to Pseudomonas aeruginosa 1.
- Key points:
- Ciprofloxacin is effective against Pseudomonas aeruginosa
- It can be used for skin and skin structure infections, including cellulitis
- Culture and susceptibility testing should be performed to confirm the effectiveness of the treatment
- Local epidemiology and susceptibility patterns should be considered in selecting or modifying antibacterial therapy 1
From the Research
For cellulitis caused by Pseudomonas aeruginosa, the most effective treatment is ceftolozane/tazobactam, as it has been shown to be active against most strains of P. aeruginosa, including those resistant to other β-lactams 2.
Treatment Options
- For mild to moderate infections, oral antibiotics such as ciprofloxacin 500-750 mg twice daily or levofloxacin 750 mg once daily may be used.
- For more severe infections, intravenous options include piperacillin-tazobactam 4.5 g every 6-8 hours, cefepime 2 g every 8-12 hours, or meropenem 1 g every 8 hours.
- In cases of fluoroquinolone resistance or severe infection, combination therapy may be necessary, often adding an aminoglycoside like tobramycin 5-7 mg/kg/day.
Important Considerations
- Pseudomonas cellulitis requires aggressive treatment due to the bacterium's intrinsic resistance mechanisms and potential for rapidly progressive infections.
- Local wound care, including debridement of necrotic tissue, is crucial for effective treatment.
- Patients should be monitored closely for clinical improvement within 48-72 hours, and antibiotic therapy should be adjusted based on culture and sensitivity results when available.
- Pseudomonal cellulitis often occurs in specific settings, such as diabetic foot infections, immunocompromised hosts, or following exposure to contaminated water, which may influence treatment decisions.