Table 4.

Preferred and alternate treatments for CRAB by infection site

Infection site	Preferredb	Alternatives, including colistin/polymyxin-sparing regimens	Therapies to avoid when alternatives exist
Bacteremia, primary or line-related	Meropenem + polymyxin B ± ampicillin–sulbactamc	Meropenem +  Minocycline ±  Ampicillin–sulbactamc OR Cefiderocol in combinationd	Tigecycline, eravacycline
Pneumoniaa	Meropenem + polymyxin B ± ampicillin–sulbactamc	Meropenem + minocycline OR Cefiderocol in combinationd	Monotherapy with any agent
Intra-abdominal infection	Tigecycline ± meropenem	Eravacycline ± meropenem	Aminoglycosides
Osteomyelitis	Minocycline ± meropenem	Eravacycline ± meropenem
UTI—pyelonephritis	Amikacin OR colistin	Gentamicin Tobramycin Cefiderocol	Tigecycline, eravacycline
UTI—cystitis	Amikacin OR colistin	Gentamicin Tobramycin Cefiderocol	Tigecycline, eravacycline
Central nervous systemb	Meropenem + polymyxin B + ampicillin–sulbactam	Meropenem + tigecycline + ampicillin–sulbactam	Aminoglycosides

^aEvidence does not support or refute local delivery of antibiotics (intrathecal, inhaled) and may be considered on a case-by-case basis

^bCombination therapy merited where source control is unachieved and/or for secondary bacteremia

^cWe prefer adding a third agent in the setting of septic shock or clinical instability while acknowledging there are no clinical data to support this approach

^dAt this time we recommend cefiderocol as an alternative treatment on the basis of the available evidence. When indicated, we recommend using in combination with an in vitro active agent