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ID Board Review/Antimicrobial Therapy/Antibacterials/Antipseudomonal

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β-Lactams with β-Lactamase inhibitors

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  • Piperacillin/Tazobactam
  • Ticarcillin/Clavulanate

Carbapenems

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  • Meropenem
  • Imipenem
  • Doripenem

Fourth Generation Cephalosporins

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  • Ceftazidime
  • Cefepime

Notes

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Double Coverage

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  • Recommended by some experts under certain circumstances[1]
    • Pts at risk for antimicrobial resistance:
      • IV Abx w/n 90 days
      • VAP with septic shock
      • ARDS preceding VAP
      • ≥5 days hospitalization prior to occurrence of VAP
      • Acute renal replacement therapy prior to VAP
    • Pts with structural lung disease (ie bronchiectasis or cystic fibrosis)
    • If >10% gram-negative isolates are resistant to an agent being considered for monotherapy
    • If local antimicrobial susceptibility is unknown
  • Double antipseudomonal coverage should have 2 different classes;
    • A β-lactam + ...
      • A Fluoroquinolone, OR
      • An Aminoglycoside
    • Aminoglycosides and Fluoroquinolones are not used as monotherapy
  • Abx should be narrowed to one, based on sensitivities

Preferred Antipseudomonal Coverage for CNS Infections

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  • Cefepime,
  • Ceftazidime, OR
  • Meropenem

Resistances

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  • Monobactams e.g. Aztreonam have a high resistance rate, but may be used in Pts with penicillin allergies.
  1. ↑ https://www.uspharmacist.com/article/updated-idsa-ats-guidelines-on-management-of-adults-with-hap-and-vap#:~:text=Double%20antipseudomonal%20antibiotic%20coverage%20from,an%20agent%20being%20considered%20for
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