infectious diseases
Pseudomonas and Related Infections
Treatment
Various antibiotics depending on site and severity of infection and susceptibility testing Hot-tub folliculitisresolves spontaneously and does not require antibiotic therapy. External otitisis treated with 1 to 2%acetic acidirrigations or topical drugs such asciprofloxacin,polymyxin B, or colistin. More severe infection is treated with fluoroquinolones if susceptible. Focal soft-tissue infectionmay require early surgical debridement of necrotic tissue and drainage of abscesses in addition to antibiotics. Small corneal ulcersare treated withciprofloxacin0.3% orlevofloxacin0.5%. Fortified (higher than stock concentration) antibiotic drops, such astobramycin15 mg/mL, are used for more significant ulcers. Frequent dosing (eg, every 1 hour around the clock) is necessary initially. Eye patching is contraindicated because it produces a dark warm environment that favors bacterial growth and prevents administration of topical drugs. Asymptomatic bacteriuriais not treated with antibiotics, except during pregnancy and before urologic manipulation. Patients with symptomatic urinary tract infections can often be treated with orallevofloxacin750 mg once a day or oralciprofloxacin500 mg 2 times a day, if the strain is susceptible. Parenteral therapy is required. Recently, single drug therapy with an active antipseudomonal beta-lactam (eg,ceftazidime) or a fluoroquinolone has been shown to produce outcomes equivalent to those of previously recommended combination therapy with an aminoglycoside plus an antipseudomonal beta-lactam, an antipseudomonal cephalosporin (eg,ceftazidime,cefepime, cefoperazone), a monobactam (eg,aztreonam), or a carbapenem (meropenem, imipenem,doripenem). Such single-drug therapy is also satisfactory for patients with neutropenia. Right-sided endocarditiscan be treated with antibiotics, but usually the infected valve must be removed to cure an infection involving the mitral, aortic, or prosthetic valve. P. aeruginosaresistance may occur among patients treated withceftazidime,cefepime,ciprofloxacin,gentamicin,meropenem, imipenem, ordoripenem. Older antibiotics (eg, colistin) may be required to treat infections involving multidrug-resistantPseudomonasspecies.Ceftolozane/tazobactam,ceftazidime/avibactam,meropenem/avibactam,meropenem/vaborbactam, imipenem/relebactam, andcefiderocolmaintain activity against many multidrug-resistant strains ofP. aeruginosa. 