Overview of Pseudomonas aeruginosa pneumonia
If Pseudomonas aeruginosa is identified in sputum, this does not always indicate pneumonia and may represent colonisation. For treatment of Pseudomonas-related exacerbations of bronchiectasis or cystic fibrosis, see Pseudomonas aeruginosa bronchiectasis exacerbations in adults, Pseudomonas aeruginosa bronchiectasis exacerbations in children or Airway infection and antibiotic therapy in cystic fibrosis.
Treatment of P. aeruginosa pneumonia depends on pneumonia severity. Assessment of pneumonia severity is included for community-acquired pneumonia (CAP) in adults and children 2 months or older, and hospital-acquired pneumonia (HAP) in adults and children.
For P. aeruginosa pneumonia in patients with high-severity pneumonia or bacteraemia, combination therapy with 2 antipseudomonal drugs is recommended until the results of susceptibility testing are available. Once susceptibility is known, combination therapy is not required.
For P. aeruginosa pneumonia in patients who do not have high-severity pneumonia or an associated bacteraemia, monotherapy with an antipseudomonal beta-lactam antibiotic (cefepime, ceftazidime, piperacillin+tazobactam) is recommended until the results of susceptibility testing are available. Aminoglycosides (eg gentamicin, tobramycin) and quinolones (eg ciprofloxacin) are not used as initial monotherapy unless there is no alternative, as resistance can develop rapidly.
The use of inhaled antibiotics for P. aeruginosa pneumonia is not recommended, except in the setting of multidrug-resistant infection under specialist supervision.