Table 3.

Recommendations for antibiotic treatment of acute invasive infection produced by P. aeruginosa

Consider surgical control of the foci (drainage, debridement) and removal of any infected foreign body (catheter u others). Include a β-lactam with activity against P. aeruginosa. Choose the β-lactam having: a) the highest probability to achieve the optimal value of the adequate pharmacokinetic/pharmacodynamic index, and b) the lowest risk of selection/amplification of the resistant subpopulation. For empirical treatment schedules, consider possible antibiotics associations during the first 48-72 h, in order to: rapidly decrease the bacterial population, avoid selection of resistant mutants (or resistant subpopulations in heteroresistant strains) and to increase the probability of the strain to be susceptible at least to one of the two antibiotics. For directed treatment schedules, consider possible antibiotics associations if the infection presents criteria for severe sepsis or septic shock, in central nervous system infections, in endocarditis, in case of neutropenia (< 500/cells/mm3) and when P. aeruginosa is resistant to β-lactams. Whatever antibiotic is chosen, it is essential to optimize the dose, route and way of administration. Consider the use of the inhalatory route in case of a severe respiratory tract infection or caused by a multidrug resistant strain.