From the Guidelines
Pseudomonas skin infections should be treated with novel β-lactam agents such as ceftolozane/tazobactam and ceftazidime/avibactam as the first-line options for targeted treatment, based on the most recent and highest quality evidence available 1.
Treatment Options
For mild localized infections, topical antibiotics like silver sulfadiazine cream or polymyxin B-containing preparations applied 2-3 times daily for 7-10 days are effective.
- For more extensive or deeper infections, oral ciprofloxacin 500-750 mg twice daily or levofloxacin 750 mg once daily for 7-14 days is recommended.
- Severe infections may require intravenous antibiotics such as piperacillin-tazobactam 4.5 g every 6 hours, ceftazidime 2 g every 8 hours, or meropenem 1 g every 8 hours for 10-14 days, as suggested by earlier guidelines 1.
Considerations
Pseudomonas aeruginosa is naturally resistant to many antibiotics due to its outer membrane permeability, efflux pumps, and ability to form biofilms, making it challenging to treat.
- Proper wound care including regular cleaning, debridement of dead tissue if necessary, and keeping the area dry are essential components of treatment.
- For patients with recurrent infections, addressing underlying conditions like diabetes or immunosuppression is crucial for preventing future occurrences.
Resistance and Alternatives
In cases of difficult-to-treat resistance, alternatives such as imipenem/cilastatin–relebactam, cefiderocol, or colistin-based therapy may be considered, as per the latest recommendations 1.
- The choice of antibiotic should be guided by susceptibility testing and clinical judgment, taking into account the severity of the infection and the patient's underlying health status.
From the FDA Drug Label
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.
1 Complicated Skin and Skin Structure Infections (Adult Patients and Pediatric Patients 3 Months of Age and Older Only) Meropenem for injection is indicated for the treatment of complicated skin and skin structure infections (cSSSI) due to Staphylococcus aureus(methicillin-susceptible isolates only), Streptococcus pyogenes, Streptococcus agalactiae, viridans group streptococci, Enterococcus faecalis(vancomycin-susceptible isolates only), Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis,Bacteroides fragilis,and Peptostreptococcusspecies.
Tobramycin and Meropenem can be used to treat skin infections caused by Pseudomonas.
- Tobramycin is indicated for the treatment of skin and skin structure infections caused by susceptible isolates of P. aeruginosa 2.
- Meropenem is indicated for the treatment of complicated skin and skin structure infections due to Pseudomonas aeruginosa 3.
From the Research
Treatment Options for Pseudomonas Skin Infections
- Ciprofloxacin has been studied as a treatment for Pseudomonas aeruginosa infections, including skin and soft tissue infections, with a clinical cure rate of 75% in patients with normal host defense mechanisms 4.
- Combination therapy with a beta-lactam and an aminoglycoside or fluoroquinolone may be effective against Pseudomonas aeruginosa infections, but the choice of therapy should be guided by the patient's risk factors, the site of infection, and the available treatment options 5, 6.
- Ceftazidime, carbapenems, and piperacillin-tazobactam have been compared as single definitive therapies for Pseudomonas aeruginosa bloodstream infection, with no significant difference in mortality, clinical failure, or microbiological failure 7.
- A systematic review and meta-analysis of randomized controlled trials found no difference in all-cause mortality between different antipseudomonal monotherapies for severe Pseudomonas aeruginosa infection, but higher clinical failure rates were observed with carbapenems versus piperacillin-tazobactam for pneumonia 8.
Antibiotic Resistance and Treatment Considerations
- The development of resistance to antipseudomonal drugs is a concern, with higher rates of resistance observed with carbapenem treatment 7, 8.
- The choice of antibiotic therapy should take into account the patient's risk factors, the site of infection, and the available treatment options, as well as the potential for resistance development 5, 6, 7, 8.
- Antimicrobial stewardship is essential to preserve the effectiveness of current antibiotics and prevent the development of resistance 5.