Intravenous therapy for P. aeruginosa bronchiectasis exacerbations in adults

Monotherapy with an antipseudomonal beta lactam is the mainstay of treatment for P. aeruginosa bronchiectasis exacerbations in adults – for advice on whether to add an aminoglycoside, see Additional intravenous therapy for Pseudomonas aeruginosa bronchiectasis exacerbations in adults.

For adults with a bronchiectasis exacerbation who require intravenous therapy, if P. aeruginosa is isolated in the sputum sample, use:

1ceftazidime 2 g intravenously, 8-hourly; see advice on modification and duration of therapy ceftazidime ceftazidime ceftazidime

2cefepime 2 g intravenously, 8-hourly; see advice on modification and duration of therapy. For dosage adjustment in adults with kidney impairment, see cefepime dosage adjustment cefepime cefepime cefepime

2piperacillin+tazobactam 4+0.5 g intravenously, 6-hourly¹; see advice on modification and duration of therapy. For dosage adjustment in adults with kidney impairment, see piperacillin+tazobactam dosage adjustment. piperacillin + tazobactam piperacillin+tazobactam piperacillin+tazobactam

For adults who have had a nonsevere (immediate or delayed) or a severe immediate² hypersensitivity reaction to a penicillin, use ceftazidime or cefepime at the dosage above.

For adults who have had a severe delayed³ hypersensitivity reaction to a penicillin, meropenem may be suitable⁴. Use:

meropenem 1 g intravenously, 8-hourly; see advice on modification and duration of therapy. For dosage adjustment in adults with kidney impairment, see meropenem dosage adjustment. meropenem meropenem meropenem

¹ For directed therapy of pseudomonal infections in adults without septic shock and those not requiring intensive care support, administration of piperacillin+tazobactam over 3 hours is preferred to ensure adequate drug exposure. However, when this is not possible (eg the patient is receiving other drugs via the same line), piperacillin+tazobactam may be administered over 30 minutes. For more information, see Practical information on using beta lactams: penicillins.Return

² Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return

³ Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return

⁴ In patients with penicillin hypersensitivity, the rate of immune-mediated cross-reactivity with carbapenems is approximately 1%; therefore, meropenem can be considered in supervised settings. However, in patients with a history of a severe cutaneous adverse reaction (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN]), consider meropenem only in a critical situation when there are limited treatment options.Return