ID Board Review/Antimicrobial Therapy/Antibacterials/Antipseudomonal

β-Lactams with β-Lactamase inhibitors

• Piperacillin/Tazobactam
• Ticarcillin/Clavulanate

Carbapenems

• Meropenem
• Imipenem
• Doripenem

Fourth Generation Cephalosporins

• Ceftazidime
• Cefepime

Notes

Double Coverage

• Recommended by some experts under certain circumstances
  • 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

• Cefepime,
• Ceftazidime, OR
• Meropenem

Resistances

• Monobactams e.g. Aztreonam have a high resistance rate, but may be used in Pts with penicillin allergies.