From the Guidelines
For Pseudomonas aeruginosa infections, the recommended antibiotic is piperacillin-tazobactam (3.375-4.5 g IV every 6 hours) or ceftazidime (2 g IV every 8 hours), as per the most recent guidelines 1. The choice of antibiotic should be based on the severity of the infection and the susceptibility of the organism.
- For carbapenem-resistant Pseudomonas aeruginosa (CRPA) infections, the recommended treatment options include piperacillin-tazobactam, ceftazidime, cefepime, or ciprofloxacin, with a treatment duration of 5-14 days 1.
- For difficult-to-treat Pseudomonas aeruginosa (DTR-PA) infections, the recommended treatment options include colistin monotherapy or combination therapy with ceftolozane/tazobactam, ceftazidime/avibactam, or imipenem/cilastatin/relebactam, with a treatment duration of 5-14 days 1. It is essential to note that local antibiogram data should guide therapy choices, as resistance patterns vary geographically.
- Monitoring for clinical improvement within 48-72 hours is crucial, and cultures with susceptibility testing should direct definitive therapy.
- Dosing adjustments are necessary for patients with renal impairment. The most recent study 1 provides the strongest evidence for the treatment of Pseudomonas aeruginosa infections, and its recommendations should be followed.
- Other studies, such as 1, 1, and 1, provide additional information on the treatment of Pseudomonas aeruginosa infections, but their recommendations are not as strong as those of the most recent study 1.
From the FDA Drug Label
1.2 Nosocomial Pneumonia Piperacillin and Tazobactam for Injection is indicated in adults and pediatric patients (2 months of age and older) for the treatment of nosocomial pneumonia (moderate to severe) caused by beta-lactamase producing isolates of Staphylococcus aureus and by piperacillin and tazobactam-susceptible Acinetobacter baumannii, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa (Nosocomial pneumonia caused by P. aeruginosa should be treated in combination with an aminoglycoside) [see Dosage and Administration (2)].
Piperacillin-tazobactam is an antibiotic that provides coverage for Pseudomonas aeruginosa, but it should be used in combination with an aminoglycoside for the treatment of nosocomial pneumonia caused by this bacterium 2, 2.
From the Research
Antibiotic Options for Pseudomonas Coverage
- The choice of antibiotic for pseudomonas coverage depends on various factors, including the site of infection, patient's risk factors, and local epidemiology 3, 4.
- According to a study published in 2019, piperacillin-tazobactam plus an aminoglycoside resulted in the highest susceptibility rate (93.3%) against Pseudomonas aeruginosa isolates 3.
- Another study published in 2002 found that the combination of a beta-lactam (such as piperacillin-tazobactam or cefepime) with an aminoglycoside (such as gentamicin) or a fluoroquinolone (such as ciprofloxacin or levofloxacin) was bactericidal and retained activity over a 24-hour period 5.
- A systematic review and meta-analysis published in 2024 found no evidence of clinical benefit differences among direct antibiotic comparisons for severe Pseudomonas aeruginosa infection, but all subgroup analyses were underpowered to detect significant differences 6.
- A retrospective study published in 2020 found no significant difference in mortality, clinical, and microbiological outcomes or adverse events between ceftazidime, carbapenems, and piperacillin-tazobactam as definitive treatment of Pseudomonas aeruginosa bacteremia 7.
Recommended Antibiotics
- Piperacillin-tazobactam plus an aminoglycoside is a recommended combination for pseudomonas coverage 3.
- Ceftazidime, carbapenems, and piperacillin-tazobactam are also considered effective options for treating Pseudomonas aeruginosa infections 6, 7.
- Novel antibiotics such as cefiderocol and new combinations of β-lactams/β-lactamase inhibitors show promising results against Pseudomonas aeruginosa 4.
Considerations for Antibiotic Choice
- Local epidemiology and patient's risk factors should guide the choice of antibiotic for pseudomonas coverage 3, 4.
- The site of infection and available treatment options should also be considered when selecting an antibiotic 4.
- Antimicrobial stewardship is essential to preserve the effectiveness of new antibiotics and prevent future development of resistance 4.