Modification of therapy for Pseudomonas aeruginosa pneumonia
Modify therapy for Pseudomonas aeruginosa pneumonia when susceptibility results are available.
For patients who received initial combination therapy (eg an aminoglycoside plus a beta lactam), once susceptibility is known, combination therapy is not required. However, aminoglycosides are not recommended as ongoing monotherapy if appropriate alternative drugs are available, because clinical outcomes may be inferior with aminoglycosides compared to an antipseudomonal beta lactam.
A switch from intravenous to oral therapy is often possible after the patient significantly improves, provided the isolate is susceptible to ciprofloxacin. For guidance on when to switch to oral therapy, see Guidance for intravenous to oral switch. Use:
ciprofloxacin 750 mg (child: 20 mg/kg up to 750 mg) orally or enterally, 12-hourly12. For dosage adjustment in adults with kidney impairment, see ciprofloxacin oral dosage adjustment. See advice on duration of therapy. ciprofloxacin ciprofloxacin ciprofloxacin
For severe infections, some experts continue intravenous therapy for the full course. In stable patients, if there is no suitable oral therapy, consider ambulatory antimicrobial therapy.
For management of patients who are not improving, see (as relevant):
- Approach to managing adults with CAP who are not improving
- Approach to managing children 2 months or older with CAP who are not improving
- Approach to managing patients with HAP who are not improving
- Approach to managing patients with VAP who are not improving.
General strategies to prevent further episodes of pneumonia in adults are outlined in Prevention of CAP in adults. For strategies to prevent hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP), see Prevention of HAP or Prevention of VAP.