Pseudomonas aeruginosa infections antibiotics

Mpller NE, Hpiby N. Antibiotic treatment of chronic Pseudomonas aeruginosa infection in cystic fibrosis patients. Scand J Infect Dis 1981 24(suppl) 87-91. 

Some polymyxins are sold for second-line systemic therapy. Polymyxin B sulfate and colistimethate sodium can be used for intravenous, intramuscular, or intrathecal achninistration, especially for Pseudomonas aeruginosa infections, but also for most other gram-negative organisms, such as those resistant to first-line antibiotics. Nephrotoxicity and various neurotoxicities are common in parenteral, but not in topical, use. Resistance to polymyxins develops slowly, involves mutation and, at least in some bacteria, adaptation, a poorly understood type of resistance that is rapidly lost on transfer to a medium free of polymyxin. Resistance can involve changes in the proteins, the lipopolysaccharides, and lipids of the outer membrane of the cell (52). Polymyxin and colistin show complete cross-resistance. 

Infections in cystic fibrosis are often due to Staphylococcus aureus, Haemophilus influenzae or Pseudomonas aeruginosa. Infecting organisms need to be identified so that the most appropriate antibiotics can be used. Antibiotics used to treat respiratory infections in cystic fibrosis commonly include ciprofloxacin, erythromycin, flu-cloxacillin and amoxicillin. However, specialist individual therapy is essential for maximum benefit to the patient and avoidance of the development of resistant strains of bacteria. 

Because an infection slows the healing of a corneal abrasion, prophylactic antibiotics are often used. Studies on the efficacy of this are mixed. Discontinue the use of contact lenses until the abrasion is healed and the antibiotic course complete. In contact lens wearers, choose an antibiotic that covers Pseudomonas aeruginosa, like gentamicin ointment or solution or a fluoroquinolone.3 Antibiotic resistance is an increasing problem. Resistance occurs primarily with older antibiotics, but has been reported for fluoroquinolones as well. Two newer fluoroquinolones, gatifloxacin and moxifloxacin, do not yet have reports of resistance. These agents are more expensive.6... 

The use of the aerosol route for delivery of antibiotics for pulmonary infections remains controversial. The majority of pediatric studies have been conducted in children with cystic fibrosis. In these patients distribution of the antibiotic to the desired tissue site is impeded because of the viscosity of the sputum in patients with acute exacerbations of their pulmonary infections [91,92], Long-term studies have demonstrated preventive benefits of aerosolized antibiotics in children with cystic fibrosis who are colonizing Pseudomonas aeruginosa in their lungs but are not acutely ill [93,94], Cyclic administration of tobramycin administered by nebulizer has received FDA approval [95],... 

Newer examples of aminoglycoside antibiotics include amikacin, neomycin (Neosporin, Cortisporin), and tobramycin (TOBI, TobraDex). Injectable tobramycin is used in the treatment of serious infections at many body sites. It has also been formulated in an inhalable dosage form that has a very specific use to treat cystic fibrosis patients having Pseudomonas aeruginosa lung infections. In the form suitable for inhalation by the patient, it delivers the antibiotic directly to the site of infection. 

L B. The patient has complicated urinary tract infection and nonsevere sepsis syndrome caused by P. aeruginosa. Effective antibiotics for Pseudomonas spp. include mezlocillin, piperacillin, piperacillin-tazobactam, ticarcillin, and ticarciUin-clavulanate. The carbapenems (imipenem and meropenem) and the monobactam (aztreonam) are also active against P. aeruginosa. Ampicillin-sulbactam and cefazolin are ineffective against P. 

Keywords Pseudomonas aeruginosa Cystic fibrosis Lipopolysaccharide Lipid A Chronic infection Antibiotic resistance Innate immunity inflammation... 

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