Additional intravenous therapy for bronchiectasis exacerbations in children with P. aeruginosa colonisation
There is limited evidence to inform whether adding an aminoglycoside to an antipseudomonal beta lactam is required for bronchiectasis exacerbations in children. Additional therapy may be required for younger children, children with more severe disease, or multidrug-resistant P. aeruginosa. Additional therapy is not necessary once susceptibility results are known or the child is clinically improvingChang, 2023Chang, 2021. Consider the harms and benefits of additional therapy and check for contraindications and precautions before prescribing an aminoglycoside (see Aminoglycoside contraindications and precautions).
If additional therapy is required for a child with a bronchiectasis exacerbation who is known to be colonised with P. aeruginosa, add to ceftazidime, cefepime or piperacillin+tazobactamChang, 2023:
1tobramycin 7 mg/kg intravenously as an initial dose1; see Principles of aminoglycoside use for prescribing considerations and subsequent dosing. See advice on modification and duration of therapy tobramycin
OR
2gentamicin 7 mg/kg intravenously as an initial dose1; see Principles of aminoglycoside use for prescribing considerations and subsequent dosing. See advice on modification and duration of therapy. 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.