Pseudomonas aeruginosa bacteraemia

Australian Commission on Safety and Quality in Health Care (ACSQHC), 2023

The following regimens apply to patients with Pseudomonas aeruginosa bacteraemia without sepsis or septic shock. For patients with sepsis or septic shock, see Pseudomonas aeruginosa sepsis or septic shock.

For patients with P. aeruginosa bacteraemia without sepsis or septic shock, use:

1ceftazidime 2 g (child: 50 mg/kg up to 2 g) intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see ceftazidime dosage adjustment. See advice on modification and duration of therapy ceftazidime ceftazidime ceftazidime

2cefepime 2 g (child: 50 mg/kg up to 2 g) intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see cefepime dosage adjustment. See advice on modification and duration of therapy cefepime cefepime cefepime

2piperacillin+tazobactam 4+0.5 g (child: 100+12.5 mg/kg up to 4+0.5 g) intravenously, 6-hourly¹. For dosage adjustment in adults with kidney impairment, see piperacillin+tazobactam dosage adjustment. See advice on modification and duration of therapy. piperacillin + tazobactam piperacillin+tazobactam piperacillin+tazobactam

For patients who have had a nonsevere (immediate or delayed) or a severe immediate² hypersensitivity reaction to a penicillin, use either cefepime or ceftazidime (see dosages above).

For patients who have had a severe delayed³ hypersensitivity reaction to a penicillin, use:

1ciprofloxacin 400 mg (child: 10 mg/kg up to 400 mg) intravenously, 8-hourly⁴. For dosage adjustment in adults with kidney impairment, see ciprofloxacin intravenous dosage adjustment. See advice on modification and duration of therapy ciprofloxacin ciprofloxacin ciprofloxacin

1meropenem 1 g (child: 20 mg/kg up to 1 g) intravenously, 8-hourly⁵ ⁶. For dosage adjustment in adults with kidney impairment, see meropenem dosage adjustment. See advice on modification and duration of therapy. meropenem meropenem meropenem

¹ For directed therapy of pseudomonal infections, 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.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 Ciprofloxacin is not licensed for use in children on the basis of animal studies that showed an adverse effect on cartilage development with quinolone use; however, clinical trial data suggest that adverse musculoskeletal events are usually mild and short term, similar to those observed in adults. Ciprofloxacin can be used in children when it is the drug of choice.Return

⁵ 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 critical illness (ie those with septic shock or requiring intensive care support).Return

⁶ 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