Anti-Pseudomonal - Antibiotics Class Overview
Pseudomonas aeruginosa is a non-fermenting Gram-negative bacillus that inhabits a variety of environments (soil, water) and causes nosocomial infections (HAP/VAP, catheter-related infections, UTIs, post-surgical) and commonly affects immunocompromised patients (common cause of neutropenic fever, ecthyma gangrenosum), cystic fibrosis, and burn patients. It is feared due both for its inherent resistance to most antibiotics as well as its propensity to develop resistance.
1. Zosyn(Piperacillin/Tazobactam) and Timentin (Ticarcillin/Clavulanate) – note high rates of resistance to Ticarcillin.
2. Carbapenems – Meropenem, Imipenem , Doripenem. Remember: Ertapenem has no activity.
3. Ceftazidime, Cefepime (4th gen cephalosporin)
4. Aztreonam – high rates of resistance at most institutions, so use only if PCN-allergic, and empirically double-cover.
5. Fluoroquinolones - Ciprofloxacin (~70% coverage) > Levofloxacin (~65%), NOT Moxifloxacin (0%) - usually used as double coverage, not for monotherapy for empiric Pseudomonas treatment.
6. Aminoglycosides – On average, Amikacin > Tobramycin > Gentamicin - generally do not use as monotherapy for serious Pseudomonas infections except for UTIs (tend to have worse outcomes), only as 2nd agent added to primary beta lactam therapy.
7. Polymyxins - Colistin (Polymyxin E) and Polymyxin B(IV)
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