This illustration video is about Pseudomonas aeruginosa. This part discusses prevention and treatment. Very use full, beautiful and highly comprehensive illustration with a lot of high yield facts and figures.
Many P. aeruginosa isolates are resistant to a large range of antibiotics and may demonstrate additional resistance after unsuccessful treatment. It should usually be possible to guide treatment according to laboratory sensitivities, rather than choosing an antibiotic empirically. If antibiotics are started empirically, then every effort should be made to obtain cultures (before administering first dose of antibiotic), and the choice of antibiotic used should be reviewed when the culture results are available.
The antibiogram of P. aeruginosaon Mueller-Hinton agar
Due to widespread resistance to many common first-line antibiotics,carbapenems, polymyxins, and more recentlytigecycline were considered to be the drugs of choice; however, resistance to these drugs has also been reported. Despite this, they are still being used in areas where resistance has not yet been reported. Use of β-lactamase inhibitors such as sulbactam has been advised in combination with antibiotics to enhance antimicrobial action even in the presence of a certain level of resistance. Combination therapy after rigorous antimicrobial susceptibility testing has been found to be the best course of action in the treatment of multidrug-resistant P. aeruginosa. Some next-generation antibiotics that are reported as being active against P. aeruginosa include doripenem, ceftobiprole, and ceftaroline. However, these require more clinical trials for standardization. Therefore, research for the discovery of new antibiotics and drugs against P. aeruginosa is very much needed. Antibiotics that may have activity against P. aeruginosa include:
• aminoglycosides (gentamicin, amikacin, tobramycin, but notkanamycin)
• quinolones (ciprofloxacin, levofloxacin, but not moxifloxacin)
• cephalosporins (ceftazidime, cefepime, cefoperazone, cefpirome,ceftobiprole, but not cefuroxime, cefotaxime, or ceftriaxone)
• antipseudomonal penicillins: carboxypenicillins (carbenicillin andticarcillin), and ureidopenicillins (mezlocillin, azlocillin, andpiperacillin). P. aeruginosa is intrinsically resistant to all otherpenicillins.
• carbapenems (meropenem, imipenem, doripenem, but notertapenem)
• polymyxins (polymyxin B and colistin)
• monobactams (aztreonam)
As fluoroquinolone is one of the few antibiotics widely effective against P. aeruginosa, in some hospitals, its use is severely restricted to avoid the development of resistant strains. On the rare occasions where infection is superficial and limited (for example, ear infections or nail infections), topical gentamicin or colistin may be used.