Monday, January 25, 2016

Efficacy of Antipseudomonal Agents

List of Antipseudomonal Agents
Antipseudomonal Agents
SENSITIVITY**

Pseudomonas sp
P. aeruginosa
Ticarcillin-clavulanate
Not available
Not available
Piperacillin-tazobactam
 83.3%

66.7%
Piperacillin
91.2%

89%
Cephalosporins


Ceftazidime
95.7%
93.2%
Cefoperazone
60.7%

79.9%

Cefoperazone/Sulbactam
88.9%

90.9%
Cefepime
100%
0%
Monobactam


Aztreonam
Not available
Not available
Fluoroquinolones


Levofloxacin


Ciprofloxacin
80%
100%
Carbapenems


Meropenem
80%
84.2%
Doripenem
Not available
Not available
Imipenem/Cilastatin
100%
85.7%
Other Antibiotics


Colistin (Polymyxin E)
Not available
Not available
Polymyxin B
Not available
Not available
Aminoglycosides


Amikacin
93.4%

100%
Gentamicin
Sensitivity to Gentamicin 10mcg:
94.5%

Sensitivity to Gentamicin 10mcg : 98.4%
Tobramycin
Not Available
Not Available
**Sensitivity results from isolates in Hospital Keningau, Sabah in 2013
  • Cefoperazone: A study done in a Malaysian general hospital showed that increased sensitivity (in vitro) observed if sulbactam is added
  • Aztreonam is not recommended to be used as monotherapy
  • Levofloxacin has no advantage over ciprofloxacin in term of coverage. Levofloxacin primarily indicated for Respiratory Tract Infection. But 750mg/day can be used in polymicrobial infection susceptible to streptococci and P. aeruginosa.
  • Other fluoroquinolones agents are not recommended (eg: Moxifloxacin)
  • MIC:
    • Doripenem< Meropenem < Imipenem
  • Imipenem less recommended due to higher risk of resistance developing during treatment.
  • All carbapenems associated with resistance emergence thus reserved in cases resistant to all other agents or polymicrobial infections
GENERAL PRINCIPLES OF TREATMENT & RECOMMENDATION
  • Empiric or Directed therapy affected by the Antibiotic Resistance (Intrinsic and acquired) Combination therapy is indicated in certain high risk patients and in severe infections. 
  • Antimicrobial therapy should be prompt, as delayed therapy correlates with increased mortality. 
  • All infected catheters should be removed, and abscesses or obstructions should be drained or removed, whenever possible
  • Choice of antibiotics should be referred from guidelines (http://askdis.blogspot.my/2016/01/antibiotic-choices-for-p-aeruginosa.html) and also the sensitivity result of the pathogen.
REFERENCES
  1. www.uptodate.com
  2.  https://www.researchgate.net/publication/14272308_In_vitro_activity_of_cefoperazone-sulbactam_combination_against_cefoperazone_resistant_clinical_isolates_in_a_Malaysian_general_hospital
  3. National Antibiotic Guidelines 2014
  4. British Medical Journal
  5. Antibiotic Guidelines 2015-2016 (John Hopkins)

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