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 circumstanceshttps://www.uspharmacist.com/article/updated-idsa-ats-guidelines-on-management-of-adults-with-hap-and-vap#:~:text=Double%20antipseudomonal%20antibiotic%20coverage%20from,an%20agent%20being%20considered%20for 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.