Additional intravenous therapy for P. aeruginosa bronchiectasis exacerbations in adults

There is limited evidence to inform whether adding an aminoglycoside to an antipseudomonal beta lactam is required for bronchiectasis exacerbations in adults. Additional therapy may be required for younger patients, patients with more severe disease, or multidrug-resistant P. aeruginosa. Additional therapy is not necessary once susceptibility results are known or the patient is clinically improving. Consider the harms and benefits of additional aminoglycoside therapy and check for contraindications and precautions before prescribing an aminoglycoside (see Aminoglycoside contraindications and precautions).

If additional therapy is required for adults with a P. aeruginosa bronchiectasis exacerbation, add to ceftazidime, cefepime or piperacillin+tazobactam:

1tobramycin intravenously; see Tobramycin initial dose calculator for adults for initial dose. See Principles of aminoglycoside use for prescribing considerations and subsequent dosing. See advice on modification and duration of therapy tobramycin tobramycin tobramycin

OR

2gentamicin intravenously; see Gentamicin initial dose calculator for adults for initial dose. See Principles of aminoglycoside use for prescribing considerations and subsequent dosing. See advice on modification and duration of therapy. gentamicin gentamicin gentamicin

The choice of aminoglycoside may be influenced by several factors, including:

  • the spectrum of activity
  • the availability of aminoglycoside therapeutic drug monitoring
  • whether the laboratory reports aminoglycoside susceptibility
  • drug cost.

There are limited clinical data to support tobramycin over gentamicin; however, the minimum inhibitory concentration (MIC) for tobramycin is slightly lower than gentamicin in vitro (particularly for P. aeruginosa) and has a greater likelihood of target attainment.