POTD: Pseudomonas Coverage


Today we discuss pseudomonas as I feel like it is easy to forget what antibiotics cover pseudomonas when you see someone with a very suspicious story in the ER. Pseudomonas Aeruginosa Review

Pseudomonas is a gram negative, aerobic rod that is commonly found everywhere. Common infections for immunocompetent patients include hot tub folliculitis. It is mostly opportunistic in that it will infect someone with a different systemic illness – burns, cystic fibrosis, etc.

For this reason, many ICUs have banned the presence of flowers or plant material being brought into the unit as gifts to quell the spread.

Pseudomonas Antibiotic Coverage Cefepime: 2g q8h IV Ceftazidime - only 3rd gen cephalosporin: 2g q8h Piperacillin-tazobactam (Zosyn): 4.5g q 6h or 3.375g q4h IV Fluoroquinolones ->Ciprofloxacin: 400mg q8-12 hours IV or 750 mg Q12h PO ->Levaquin can cover both strep and pseudomonas: 750mg PO Daily Carbapenems ->Meropenem: 1g q8h IV Aztreonam: 2g q8h IV

If very critical – pursue double coverage (penicillin/beta-lactamase inhibitor with an added aminoglycoside) Gentamicin: 5mg/kg IV Tobramycin 5mg/kg IV Amikacin 15mg/kg IV (Adjusted Body Weight)

Considerations for Resistant Pseudomonas ICU Stay Bedridden Invasive Devices Prior use of antibiotics recently Diabetes Mellitus Patients undergoing surgery

Pseudomonas generally ends up being a problem for patients who have been hospitalized for significant times but it should be a consideration for patients who arrive ventilated, chronically ill or after recent admissions. Unless of course you practice in an environment with many dirty hot tubs.