What is the treatment for Pseudomonas (Pseudomonas aeruginosa) skin infection?

From the Guidelines

Pseudomonas skin infections are typically treated with a combination of antibiotics and proper wound care, with anti-pseudomonal penicillins or cephalosporins or fluoroquinolones, with or without an aminoglycoside, recommended for treatment of infections due to CRPA susceptible to other antimicrobial agents 1. For mild to moderate infections, ciprofloxacin 500mg twice daily for 7-10 days is often effective, as it has been shown to be effective against Pseudomonas aeruginosa 1. Alternatively, levofloxacin 750mg once daily for 7-10 days can be used, as it also has broad-spectrum activity against Pseudomonas aeruginosa 1. Some key points to consider when treating pseudomonas skin infections include:

• The importance of proper wound care, including cleaning the affected area with sterile saline solution, removing any dead tissue, and applying appropriate dressings 1
• The need to monitor for signs of worsening infection, such as increasing redness, swelling, pain, or fever, which would require immediate medical attention 1
• The potential for Pseudomonas aeruginosa to form biofilms that protect the bacteria from treatment, making it essential to use antibiotics that are effective against biofilm-producing strains 1
• The importance of considering the patient's underlying conditions, such as diabetes or vascular disease, when selecting an antibiotic regimen 1 Some specific treatment options for pseudomonas skin infections include:
• Ciprofloxacin 500mg twice daily for 7-10 days for mild to moderate infections 1
• Levofloxacin 750mg once daily for 7-10 days for mild to moderate infections 1
• Piperacillin-tazobactam 4.5g every 6 hours or cefepime 2g every 8 hours for more severe infections 1
• Silver sulfadiazine cream for infected burns or hot tub folliculitis (common pseudomonas infections) 1

From the FDA Drug Label

1.6 Complicated Skin and Skin Structure Infections Levofloxacin tablets are indicated for the treatment of complicated skin and skin structure infections due to methicillin-susceptible Staphylococcus aureus, Enterococcus faecalis, Streptococcus pyogenes, or Proteus mirabilis 1.7 Uncomplicated Skin and Skin Structure Infections Levofloxacin tablets are indicated for the treatment of uncomplicated skin and skin structure infections (mild to moderate) including abscesses, cellulitis, furuncles, impetigo, pyoderma, wound infections, due to methicillin-susceptible Staphylococcus aureus, or Streptococcus pyogenes. 1.5 Skin and Skin Structure Infections Tobramycin for Injection is indicated for the treatment of skin and skin structure infections caused by susceptible isolates of P. aeruginosa, Proteus spp., E. coli, Klebsiella spp., Enterobacter spp., and S. aureus in adult and pediatric patients.

Pseudomonas skin infection can be treated with levofloxacin or tobramycin.

• Levofloxacin is indicated for the treatment of complicated skin and skin structure infections due to susceptible isolates, but it does not explicitly mention Pseudomonas as a cause of these infections.
• Tobramycin is indicated for the treatment of skin and skin structure infections caused by susceptible isolates of P. aeruginosa. It is essential to note that the treatment should be based on the results of culture and susceptibility testing to ensure the chosen antibiotic is effective against the specific strain of Pseudomonas causing the infection 2 3.

From the Research

Pseudomonas Skin Infection Overview

• Pseudomonas aeruginosa is an opportunistic pathogen that can cause skin infections, particularly in vulnerable hosts 4.
• Skin manifestations of P. aeruginosa infections can range from localized infections to life-threatening systemic disease 5.
• Common skin infections caused by P. aeruginosa include green nail syndrome, toe web infection, hot tub folliculitis, hot hand-foot infection, and external otitis 4.

Clinical Features and Management

• Clinical features of P. aeruginosa skin infections can include ecthyma gangrenosum, subcutaneous nodules, and necrotizing skin and soft tissue infections 4.
• Management of P. aeruginosa skin infections typically involves local treatments, such as topical antibiotics, and systemic antibiotics in severe cases 4, 5.
• Combination therapy with multiple antibiotics may be necessary in some cases, particularly in patients with multidrug-resistant infections 6.

Treatment Options

• Silver sulfadiazine (SSD) has been shown to be effective in eradicating P. aeruginosa biofilms in wound infections, including diabetic foot ulcers 7.
• SSD may also be effective in reducing the bioburden of P. aeruginosa in polymicrobial mixed infections, but may not provide adequate coverage for Candida infections 8.
• Novel antibiotics, such as cefiderocol, and bacteriophage therapy may also be effective in treating P. aeruginosa infections 6.

Epidemiology and Risk Factors

• P. aeruginosa skin infections can occur in anyone, but are more common in patients with underlying medical conditions, such as diabetes or immunocompromised states 4, 5.
• Risk factors for P. aeruginosa skin infections include exposure to contaminated water, poor hygiene, and use of invasive medical devices 4, 5.