TABLE 3.
| Source | Preferred treatment | Alternative treatment¶¶ |
|---|---|---|
| Pseudomonas aeruginosa | ||
| Pyelonephritis or complicated UTI§ | Ciprofloxacin or Aminoglycosides or Ceftazidime or Cefepime or Piperacillin-tazobactam |
Meropenem or Imipenem-cilastin or Colistin or polymyxin B |
| Infections outside of the urinary tract | Ceftazidime or Cefepime or Piperacillin-tazobactam or Meropenem or Imipenem-cilastatin or Colistin or polymyxin B |
Aminoglycosides (Limited to uncomplicated bloodstream infections with complete source control¶) or Ceftolozane-tazobactam†† |
| Enterobacterales (SPICE)‡‡ | ||
| Pyelonephritis or complicated UTI§ | Ciprofloxacin or Aminoglycosides or Piperacillin-tazobactam or Cefepime or Ertapenem |
Meropenem or Imipenem-cilastin |
| Biliary sepsis | Piperacillin-tazobactam or Cefepime or Ertapenem |
Meropenem or Imipenem-cilastin or Ceftolozane-tazobactam†† |
| Complicated intra-abdominal infections | Tigecycline§§ or Piperacillin-tazobactam or Cefepime or Ertapenem |
Meropenem or Imipenem-cilastin or Ceftolozane-tazobactam†† |
| Pneumonia | Piperacillin-tazobactam or Cefepime or Ertapenem |
Meropenem or Imipenem-cilastin or Ceftolozane-tazobactam†† |
| Primary bacteraemia | Ertapenem | Meropenem or Imipenem-cilastin or Ceftolozane-tazobactam†† |
UTI, urinary tract infection; SPICE, Serratia spp., P. aeruginosa, indole-positive Proteeae (Morganella morganii, Providencia rettgeri and Providentia stuartii), Citrobacter spp., and Enterobacter spp.; XDR, extensive drug-resistant; PDR, pan-drug-resistant.
, Assuming in vitro susceptibility to agents in the table.
, Refer to Table 5 for recommended dosing and administration schedules for adult critically ill patients with normal renal function.
, Complicated UTI, is defined as ‘UTI that occurs in association with a structural or functional abnormality of the genitourinary tract, or any UTI in a male patient’. This excludes UTIs in catheterised patients or caused by a resistant bacterium.
, Uncomplicated bloodstream infections include a bloodstream infection that is because of a urinary source or a catheter-related bloodstream infection with removal of the infected vascular catheter.
, Ceftolozane-tazobactam only in difficult-to-treat resistant infections that is, as an antibiotic of last resort.
, Very little data to guide colistin or polymyxin combination therapy or otherwise for AmpC-producing Enterobacterales is available and therefore these antibiotics have not been included.
, Morganella spp., Proteus spp. and Providencia spp. are inherently resistant to tigecycline.
, If 1st line options are not susceptible, not available or tolerated or in cases of confirmed bacteriological and clinical failure.