Which empiric antibiotics are indicated in bacterial pneumonia with an increased risk of Pseudomonas infection?

Updated: Sep 30, 2020
  • Author: Justina Gamache, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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For patients at increased risk of infection with Pseudomonas (acceptable for both ICU and non-ICU patients), choose one option below:

  • IV antipseudomonal beta-lactam plus IV antipseudomonal quinolone (PO quinolone in non-ICU patients only)

  • IV antipseudomonal beta-lactam plus IV aminoglycoside plus one of the following: (1) IV macrolide; (2) IV antipneumococcal quinolone (PO in non-ICU patients only); or (3) if the patient has a documented beta-lactam allergy, administer IV aztreonam plus IV aminoglycoside plus IV antipneumococcal quinolone (PO quinolone in non-ICU only)

  • The question of the need for “double coverage” for possible drug-resistant pseudomonal organisms often arises when treating critically ill patients. The use of two antipseudomonal medications should only be considered in critically ill patients who are at high risk for infection with drug-resistant organisms. Double coverage should be given as initial therapy early in the course of treatment in order to make an impact in the disease course.

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