Stenotrophomonas maltophilia pneumonia
Stenotrophomonas maltophilia is frequently identified in sputum, though this almost always represents colonisation. Rarely, S. maltophilia may cause pneumonia, which can usually be treated with trimethoprim+sulfamethoxazole.
Seek expert advice for management of S. maltophilia pneumonia in children.
For adults with S. maltophilia pneumonia who cannot tolerate or absorb oral therapy, use:
trimethoprim+sulfamethoxazole (adult) 5+25 mg/kg up to 480+2400 mg intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see trimethoprim+sulfamethoxazole dosage adjustment. For duration of therapy, seek expert advice trimethoprim + sulfamethoxazole trimethoprim+sulfamethoxazole trimethoprim+sulfamethoxazole
If the patient can tolerate and absorb oral therapy, use:
trimethoprim+sulfamethoxazole (adult) 5+25 mg/kg up to 480+2400 mg orally, 8-hourly. For calculated weight-banded doses in number of double-strength tablets, see Calculated dose and number of tablets of trimethoprim+sulfamethoxazole to achieve a 5+25 mg/kg dose in adults. For dosage adjustment in adults with kidney impairment, see trimethoprim+sulfamethoxazole dosage adjustment. For duration of therapy, seek expert advice.trimethoprim + sulfamethoxazoletrimethoprim+sulfamethoxazole trimethoprim+sulfamethoxazole
If the trimethoprim+sulfamethoxazole dosages above are not tolerated, consider giving the same total daily dose more frequently (eg divided into 4 daily doses and given 6-hourly). Alternatively, as a second-line option, reduce the total daily dose – seek expert advice. If trimethoprim+sulfamethoxazole cannot be used or for S. maltophilia resistant to trimethoprim+sulfamethoxazole, seek expert advice.
For management of patients who are not improving, see (as relevant):
- Approach to managing adults 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.