What are the oral antibiotic options for Pseudomonas (Pseudomonas aeruginosa) wound infections?

From the Guidelines

Oral antibiotics for treating Pseudomonas wound infections include ciprofloxacin (500-750mg twice daily) and levofloxacin (750mg once daily), both from the fluoroquinolone class, as recommended by the 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections 1. When considering oral options for Pseudomonas wound infections, it's essential to note that these medications are typically prescribed for 7-14 days depending on infection severity.

• Ciprofloxacin is often preferred due to its excellent activity against Pseudomonas aeruginosa.
• For more resistant strains, combination therapy may be necessary, potentially adding oral trimethoprim-sulfamethoxazole (TMP-SMX) or using intravenous options instead. Before starting treatment, wound cultures should be obtained to confirm the presence of Pseudomonas and determine antibiotic susceptibility, as resistance is increasingly common 1.
• Patients should take the full course of antibiotics even if symptoms improve,
• take fluoroquinolones on an empty stomach or two hours after meals, and
• stay hydrated. Fluoroquinolones work by inhibiting bacterial DNA gyrase and topoisomerase IV, preventing DNA replication and ultimately killing the bacteria. Local wound care with regular cleaning and debridement remains essential alongside antibiotic therapy, as emphasized in the guidelines 1. It's crucial to consider the results of culture and sensitivity testing in light of the clinical response of the infection to the empiric regimen, and to adjust the treatment accordingly 1. In cases where Pseudomonas aeruginosa is isolated, specifically targeted antibiotic coverage may be necessary, and clinicians should consider covering ESBL-producing gram-negative isolates, especially in countries in which they are relatively common 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 [see Clinical Studies (14.5)].
2. 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. 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

Oral options for pseudomonas wound include:

• Levofloxacin (PO): indicated for the treatment of complicated skin and skin structure infections, including those caused by Pseudomonas aeruginosa is not explicitly mentioned but Pseudomonas aeruginosa is mentioned in other indications 2
• Ciprofloxacin (PO): indicated for the treatment of skin and skin structure infections caused by Pseudomonas aeruginosa 3

From the Research

Oral Options for Pseudomonas Wound Infections

• Ciprofloxacin is an effective oral option for the treatment of Pseudomonas aeruginosa infections, including those of the skin and soft tissue 4, 5.
• The therapeutic efficacy and safety of ciprofloxacin have been studied in patients with Pseudomonas aeruginosa infections, with clinical cure and eradication of bacteria achieved in 75% of patients receiving only ciprofloxacin 4.
• Levofloxacin has also been shown to have excellent bactericidal activity against Pseudomonas aeruginosa, with in vitro activity comparable to that of ciprofloxacin 6.
• Novel fluoroquinolones, such as levofloxacin, have been introduced and show favorable activity against Pseudomonas aeruginosa 7.
• Oral ciprofloxacin has been compared to parenteral cefotaxime in the treatment of difficult skin and skin structure infections, with oral ciprofloxacin showing comparable efficacy and safety 8.

Key Findings

• Ciprofloxacin and levofloxacin are effective oral options for the treatment of Pseudomonas aeruginosa infections.
• The emergence of resistant Pseudomonas aeruginosa strains is a concern, and larger studies are needed to evaluate the risk of resistance to ciprofloxacin 4, 8.
• Combination therapy may be recommended in limited scenarios, and extended-infusion of β-lactams may exhibit clinical benefit 7.