Intravenous therapy for bronchiectasis exacerbations in children with P. aeruginosa colonisation

The recommendations below apply to children who require intravenous therapy and have known P. aeruginosa colonisation1 – if P. aeruginosa is newly identified, refer the child to a respiratory physician for eradication therapy.

For P. aeruginosa bronchiectasis exacerbations in children, there is limited evidence to inform the optimal empirical regimen and whether to add an aminoglycoside (see Additional intravenous therapy for P. aeruginosa bronchiectasis exacerbations in children)Chang, 2023Chang, 2021.

If P. aeruginosa is isolated in the respiratory sample of a child with a bronchiectasis exacerbation who is known to be colonised with P. aeruginosa and who requires intravenous therapy, while awaiting expert advice, use:

1ceftazidime 50 mg/kg up to 2 g intravenously, 8-hourly; see advice on modification and duration of therapy ceftazidime

OR

2cefepime 50 mg/kg up to 2 g intravenously, 8-hourly; see advice on modification and duration of therapy cefepime

OR

2piperacillin+tazobactam 100+12.5 mg/kg up to 4+0.5 g intravenously, 6-hourly2; see advice on modification and duration of therapy. piperacillin + tazobactam

For children who have had a nonsevere (immediate or delayed) or a severe immediate3 hypersensitivity reaction to a penicillin, use ceftazidime or cefepime at the dosage above.

For children who have had a severe delayed4 hypersensitivity reaction to a penicillin, meropenem may be suitable5. Use:

meropenem 20 mg/kg up to 1 g intravenously, 8-hourly6; see advice on modification and duration of therapy. meropenem

1 A suggested definition of colonisation with P. aeruginosa is 2 positive culture results of respiratory samples, at least 3 months apart, within the past 12 months.Return
2 For directed therapy of pseudomonal infections in children without septic shock, administration of piperacillin+tazobactam over 3 hours is preferred to ensure adequate drug exposure. However, when this is not possible (eg the child 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
3 Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return
4 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
5 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
6 Some centres use a meropenem dosage of 40 mg/kg up to 2 g intravenously, 8-hourly for children who are very unwell; however, no data are available to support the use of this dosage except in children with central nervous system infection or septic shock.Return