Pseudomonas infection, treatment

These agents generally have been replaced by more agents due to resistance. This combination is highly effective against most aerobic enteric bacteria except Pseudomonas aeruginosa. High urinary tract tissue levels and urine levels are achieved, which may be important in complicated infection treatment. Also effective as prophylaxis for recurrent infections,... 

Getttamidtt. Gentamicin is widely used in the treatment of severe infections. Uses include septicemia, neonatal sepsis, neonatal meningitis, biliary tract infection, pyelonephritis, prostatitis, and endocarditis. Gentamicin is frequently used for empiric therapy in presmned gramnegative bacillary infections before the identification and susceptibility of the causative organism are known. Patients with cystic fibrosis and those in intensive care imits often have Pseudomonas infections and are typically treated with gentamicin. 

As previously noted, carbenicillin is the only widely used /3-lactam antibiotic for the treatment of infection caused by Ps. aeruginosa. Table 7.5 shows the MIC values of fifty strains of Ps. aeruginosa for a range of j8-lactam antibiotics. From the Table, carbenicillin is the only active drug and at the present time it is the least toxic agent with significant activity in the treatment of pseudomonas infections. It may be used alone or in combination with other antibiotics, e.g. aminoglycosides (see Table 7.1). 

Two adults are well on y-globulin prophylaxis. Repeated immunization against staphylococcal antigens helped one man until his death at 20 years from pseudomonas infection (D3). A girl was well on y-globulin treatment for 6 months when this had been discontinued for a further 6 months, against advice, she died from her third proven staphylococcal septicemia. 

Kasuqaroycin. — The unique structure of kasugamycin was established as an aminoglycoside containing a carboxyamidino grouping.This inhibitor of polypeptide synthesis has low toxicity and it is of particular interest for treatment of Pseudomonas infections. 

Kanamycin. — With the exception of Pseudomonas infections, kanamycin has proved to be a valuable antibiotic for the treatment of drug-resistant tuberculosis and serious infections caused by gram-negative bacilli. 

There would seem to be no reason for avoiding concurrent use in patients with normal renal function because no significant in vivo inactivation appears to occur. Moreover there is good clinical evidence that concurrent use is valuable, especially in the treatment of Pseudomonas infections. 

Pefloxacin (33) is the N-methyl analogue of norfloxacin (58) and is at least partly converted to it by metabolic enzymes in vivo. It has been launched in France for the treatment of a number of infections including those caused by sensitive strains of Pseudomonas aeruginosa. It can be synthesized starting with the Gould-Jacobs reaction of 3-chloro-4-fluoroaniline (28) and diethyl ethoxymethylenemalonate in an addition-elimination sequence leading to 29 which undergoes... 

Hodson, M.E., Penketh, A.R. and Batten, J.C. (1981). Aerosol carbenicillin and gentamicin treatment of Pseudomonas aeruginosa infection I patients with cystic fibrosis. Lancet 2 1137-1139. 

---