TABLE 4.
| Source | Preferred treatment | Alternative treatment¶¶¶ |
|---|---|---|
| Pyelonephritis or complicated UTI§ | ||
| Aminoglycosides or Ciprofloxacin |
Meropenem or imipenem-cilastatin | |
| Infections outside of the urinary tract¶ | ||
| Biliary sepsis | Meropenem or imipenem-cilastatin†† plus 2nd active antibiotic or Tigecycline§§ with/out 2nd active antibiotic or Colistin or polymyxin B¶¶ plus 2nd active antibiotic |
Ceftazidime-avibactam (OXA-48, KPC, GES)‡‡ or Aztreonam plus Ceftazidime-avibactam (NDM, IMP, VIM)‡‡ |
| Complicated intra-abdominal infections | Meropenem or imipenem-cilastatin†† plus 2nd active agent or Tigecycline§§ plus 2nd active antibiotic or Colistin or polymyxin¶¶ plus 2nd active antibiotic |
Ceftazidime-avibactam (OXA-48, KPC, GES)‡‡,††† or Aztreonam plus Ceftazidime-avibactam (NDM, IMP, VIM)‡‡,††† |
| Pneumonia | Meropenem or imipenem-cilastatin†† plus 2nd active agent or Colistin or polymyxin B¶¶ plus 2nd active antibiotic |
Ceftazidime-avibactam (OXA-48, KPC, GES)‡‡ or Aztreonam plus Ceftazidime-avibactam (NDM, IMP, VIM)‡‡ |
| Primary bacteraemia | Meropenem or imipenem-cilastatin†† plus 2nd active agent or Colistin or polymyxin B¶¶ plus 2nd active antibiotic |
Ceftazidime-avibactam (OXA-48, KPC, GES)‡‡ or Aztreonam plus Ceftazidime-avibactam (NDM, IMP, VIM)‡‡ |
UTI, urinary tract infections; OXA-48, Oxacillinase-48; MBL, Metallo-β-lactamase; NDM, New-Delhi metallo-β-lactamase; VIM, Verona Integron-encoded metallo-β-lactamase; IMP, Imipenemases; KPC, Klebsiella pneumoniae carbapenemase; MIC, minimum inhibitory concentration.
, 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.
, In certain clinical scenarios, and requiring close monitoring for clinical response, monotherapy with an active agent may be considered by a stewardship team.
, According to carbapenem MIC and reported as susceptible. Generally, if MIC reported as ≤8 mg/L combine with another active agent while if MIC ≤ 2 mg/L, monotherapy at optimised dosing, may be considered in selected cases.
, Ceftazidime-avibactam only in difficult-to-treat infections that is, as an antibiotic of last resort.
, Morganella spp., Proteus spp. and Providencia spp. are inherently resistant to tigecycline.
, Proteus spp., Serratia marcescens, Providencia spp. and Morganella morganii are inherently resistant to colistin and polymyxin B.
, Complicated intra-abdominal infections are the indication with the most scope for inappropriate use of ceftazidime-avibactam and resistance emerging relating to prolonged use without adequate source control.
, If 1st line options are not susceptible, not available or tolerated or in cases of confirmed bacteriological and clinical failure.