Pseudomonas aeruginosa pneumonia in patients who do not have high-severity pneumonia or an associated bacteraemia

Australian Commission on Safety and Quality in Health Care (ACSQHC) 2023 Kalil 2016

For initial treatment of Pseudomonas aeruginosa pneumonia in patients who do not have high-severity pneumonia or an associated bacteraemia, while awaiting susceptibility results, 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 intravenous to oral switch and duration of therapy ceftazidime ceftazidime ceftazidime

2cefepime 2g (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 intravenous to oral switch 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 intravenous to oral switch 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 the ceftazidime or cefepime regimen above for initial therapy while awaiting susceptibility results.

For patients who have had a severe delayed³ hypersensitivity reaction to a penicillin, meropenem may be suitable⁴ for initial therapy while awaiting susceptibility results. Use:

meropenem 1 g (child: 20 mg/kg up to 1 g) intravenously, 8-hourly⁵. For dosage adjustment in adults with kidney impairment, see meropenem dosage adjustment. See advice on intravenous to oral switch 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 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

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 septic shock.Return