ID Board Review/Antimicrobial Therapy/Antibacterials/Antipseudomonal

β-Lactams with β-Lactamase inhibitors

 * Piperacillin/Tazobactam
 * Ticarcillin/Clavulanate

Carbapenems

 * Meropenem
 * Imipenem
 * Doripenem

Fourth Generation Cephalosporins

 * Ceftazidime
 * Cefepime

=Notes=

Double Coverage

 * Recommended by some experts under certain circumstances
 * Pts at risk for antimicrobial resistance:
 * IV Abx w/n 90 days
 * VAP with septic shock
 * ARDS preceding VAP
 * ≥5 days hospitalization prior to occurrence of VAP
 * Acute renal replacement therapy prior to VAP
 * Pts with structural lung disease (ie bronchiectasis or cystic fibrosis)
 * If >10% gram-negative isolates are resistant to an agent being considered for monotherapy
 * If local antimicrobial susceptibility is unknown
 * Double antipseudomonal coverage should have 2 different classes;
 * A β-lactam + ...
 * A Fluoroquinolone, OR
 * An Aminoglycoside
 * Aminoglycosides and Fluoroquinolones are not used as monotherapy
 * Abx should be narrowed to one, based on sensitivities

Preferred Antipseudomonal Coverage for CNS Infections

 * Cefepime,
 * Ceftazidime, OR
 * Meropenem

=Resistances=
 * Monobactams e.g. Aztreonam have a high resistance rate, but may be used in Pts with penicillin allergies.