"Super Gram Negative" Antibiotics that cover Pseudomonas

Question 1

What is the suggested regimen for serious infections thought to be caused by Pseudomonas?

What families of Abx are typically used in this regimen?

Answer 1

DOUBLE COVERAGE!

• two Abx from different classes until susceptibilities determined, then switch to single coverage

Beta-Lactam + Fluoroquinolone/Aminoglycoside

Question 2

What 6 Abx can be used for the treatment of Pseudomonas?

Answer 2

1. Zosyn/Timentin
2. Carbapenems (Ertepenem has NO activity)
3. Ceftazidime/Cefepime (4th Gen cephalosporin)
4. Aztreonam (PCN-allergies)
5. Fluoroquinolones (Cipro > Levo)
6. Aminoglycosides (Amikacin > Tobramycin > Gentamicin)

Question 3

Which carbapenem has no activity against Pseudomonas?

Answer 3

Ertepenem

Question 4

Which fluoroquinolone has better activity against Pseudomonas: Ciprofloxacin or Levofloxacin?

Answer 4

Ciprofloxacin

• Levofloxacin can be used but minorly less effective

Question 5

Which fluoroquinolone has no activity against Pseudomonas?

Answer 5

Moxifloxacin

Question 6

What is the initial Abx regimen for coverage of possible Multi-Drug Resistant (MDR) organisms in cases of HCAP/HAP/VAP?

Answer 6

2-3 drug regimen that covers for MRSA and Pseudomonas

MRSA = Vancomycin/Linezolid
Pseudomonas = Beta Lactam + Fluoroquinolone/Aminoglycoside