1. TREATMENT FOR SUPERIMPOSED PSEUDOMONAS AERUGINOSA INFECTION

2. Pseudomonas aeruginosa Antibiotic Selection takes into account local patterns of antimicrobial susceptibility

3. Combination therapy • in most severe infections due to P. Aeruginosa , two antipseudomonal antibiotics to which the strain is sensitive should be administered together • Benefits of this combined therapy: • Increased efficacy (more efficacious than monotherapy) • Achievement of additive or synergistic killing • Prevention of antibiotic resistance emergence Fauci et al. Harrison’s Principles of Internal Medicine

4. Antimicrobial agents active against Pseudomonas aeruginosa aminoglycosides (gentamicin, amikacin, tobramycin) quinolones (ciprofloxacin, levofloxacin, and moxifloxacin) cephalosporins (ceftazidime, cefepime, cefoperazone, cefpirome, but notcefuroxime, ceftriaxone, cefotaxime) ureidopenicillins and carboxypenicillins (piperacillin, ticarcillin: P. aeruginosa is intrinsically resistant to all other penicillins) carbapenems (meropenem, imipenem, doripenem, but notertapenem) polymyxins (polymyxin B and colistin) monobactams (aztreonam) Fauci et al. Harrison’s Principles of Internal Medicine

5. Duration of Antibiotic therapy depends on: Type Location Severity of infection * In general: therapy lasts for weeks or even months rather than days Fauci et al. Harrison’s Principles of Internal Medicine

6. Antibiotic Resistance in P. aeruginosais both: Intrinsic - as reflected by the relative paucity of antibiotics with inherent activity against wild type strains Acquired - as defined by high level resistance to agents that normally would be expected to exhibit antimicrobial activity Fauci et al. Harrison’s Principles of Internal Medicine

7. Fauci et al. Harrison’s Principles of Internal Medicine

8. Fauci et al. Harrison’s Principles of Internal Medicine