Table 1. Minimum Inhibitory Concentrations of P. aeruginosa for Selected Antibiotics
|
|
|
MIC(mg/L) |
|
|
Antibiotic |
MIC50 |
MIC90 |
Range |
|
|
|
|
|
|
Extended spectrum Penicillins Piperacillin Ticarcillin Carbenicillin |
4 32 64 |
64 128 256 |
1 - >128 1 - >128 8 - 512 |
|
Extended spectrum Penicillins plus Beta-lactamase inhibitors |
|||
|
Piperacillin-Tazobactam1 Ticarcillin-Clavulanate1 |
4 32 |
64 128 |
1 - >128 1 - >128
|
|
Cephalosporins Third Generations Ceftazidime Cefoperazone Cefotaxime Ceftriaxone Ceftizoxime Cefpodoxime |
2 8 16 16 32 >128 |
8 32 64 64 128 >128 |
0.5-128 0.25 - >128 0.25 - >64 0.25 - >64 2 - >128 >128 |
|
Fourth Generation Cefepime Cefpirome |
4 16 |
16 32 |
1 - 32 4 - >128 |
|
Other beta-lactams Meropenem Imipenem Ertapenem Aztreonam |
1 2 8 8 |
2 8 >16 16 |
0.06 - 16 0.5 - 256 0.12 - >16 0.5 - 256
|
|
Quinolones Ciprofloxacin Levofloxacin Ofloxacin Gatifloxacin Moxifloxacin Garenofloxacin Norfloxacin |
0.25 0.5 1 1 2 2 2 |
16 32 32 32 32 >32 32 |
0.32 - 32 0.12 - 32 0.25 - 32 0.5 - 32 0.5 - 32 0.25 - >32 0.2 - 32
|
|
Aminoglycosides Tobramycin Gentamicin Amikacin Netilmicin |
2 4 8 8 |
4 16 16 32 |
0.25 - >512 2 - >512 1 - 128 1 - 64
|
|
Other antibiotics Tigecycline |
8 |
>8 |
4 - >8 |
Adapted from (46, 75, 76, 88, 224)
Table 2: Drug of Choice [Total Daily Dose (Dosing Interval in Hours)]
|
Class |
Antibiotic |
Route |
Adult Dose |
Pediatric Dose * |
Alternative Dosing |
|
Aminoglycoside |
amikacin |
IV |
7.5 mg/kg IV (12) |
15-30 mg/kg IV (8) |
15 mg/kg IV (24) |
|
Aminoglycoside |
colistin |
IT/inhaled |
Toxic for IV Use |
Toxic for IV Use |
N/A |
|
Aminoglycoside |
gentamicin |
IV |
2 mg/kg load, then 5 mg/kg IV (8) |
7.5 mg/kg IV (8) |
5-7 mg/kg IV (24) |
|
Aminoglycoside |
tobramycin |
IV/inhaled |
2 mg/kg load, then 5 mg/kg IV (8) |
7.5-10.5 mg/kg IV (8) |
5-12 mg/kg IV (24) |
|
Carbapenem |
imipenem/cilastatin |
IV/IM |
1-4 gm IV (6) |
60-100 mg/kg IV (6) |
N/A |
|
Carbapenem |
meropenem |
IV |
1.5-6 gm IV (8) |
60-120 mg/kg IV (8) |
125-250mg/hour IV |
|
Cephalosporin: 3rd generation |
ceftazidime |
IV/IM |
3-6 gm IV (8-12) |
90-150mg/kg IV (8) |
N/A |
|
Cephalosporin: 4th generation |
cefepime |
IV |
2-6 gm IV (8) |
100-150mg/kg IV (8) |
Load 15 mg/kg then 100 mg/kg IV infused over 24 hours |
|
Fluoroquinolone |
ciprofloxacin |
PO/IV |
500-1500 mg po (12); 400-800 mg IV (8-12) |
30 mg/kg PO/IV (12) |
N/A |
|
Fluoroquinolone |
levofloxacin |
PO/ IV |
500-750 mg PO IV (24) |
10 mg/kg PO/ IV (24) |
N/A |
|
Monobactam |
aztreonam |
IV |
3-8 gm IV (6-8) |
90-200mg/kg (8) |
N/A |
|
Penicillin: antipseudomonal |
ticarcillin |
IV |
4-24 gm (4-6) |
300- 600 mg/kg IV (8) |
N/A |
|
Penicillin: antipseudomonal |
piperacillin |
IV |
8-24 gm IV (4-6)
|
200-600 mg/kg IV (8) |
3.375 g infused over 4 hours (8) |
| Polymyxin | colistin | IT (use In for inhaled ?)/inhaled | 150-300 mg IN (12) | 80-300 mg IN (12) | N/A |
| colistin | IV | 2.5-5 mg/kg IV (8) MAX 160 mg/dose | 2.5-5 mg/kg IV (8)-MAX 160 mg/dose | IM (extremely painful) | |
| colistin | IT | 3.2-10 mg IT (24) | Not sure there is data to recommend | N/A |
*Dose in neonates may need to be adjusted Note: Doses in renal failure may need to be adjusted
N/A=Not Available; IM= Intramuscular; IV= Intravenous; PO=Oral; gm=gram; mg= milligram; kg=kilogram
Table 3: Special Infections [Total Daily Dose (Dosing Interval in Hours)]
|
Infection |
Antibiotic |
Adult Dose |
Pediatric Dose* |
Aminogylcoside? |
Duration |
|
Cystic Fibrosis: mild exacerbation/ sinusitis |
ciprofloxacin |
1500 mg po (12) |
30 mg/kg po (12) |
No |
14-21 days |
|
Cystic Fibrosis: fails oral therapy |
**cefepime |
6 gm IV (12) |
150 mg/kg IV (12) |
tobramycin or amikacin |
10-21 days |
|
|
ceftazidime |
6 gm IV (8) |
150 mg/kg IV (8) |
tobramycin or amikacin |
10-21 days |
|
|
**meropenem |
6 gm IV (8) |
320 mg/kg IV (8) |
tobramycin or amikacin |
10-21 days |
|
|
**piperacillin or piperacillin/ tazobactam |
24gm IV (4) |
600 mg/kg IV (6) |
tobramycin or amikacin |
10-21 days |
|
|
ticarcillin or ticarcillin-clavulenate |
24 gm IV (4-6)
|
600 mg/kg IV (6-8)
|
tobramycin or amikacin |
10-21 days |
|
Infective Endocarditis |
cefepime |
6 gm IV (8) |
150 mg/kg IV (8) |
Yes |
42 days |
|
|
ceftazidime |
6 gm IV (8) |
150 mg/kg IV (8) |
Yes |
42 days |
|
|
piperacillin |
24 gm IV (4-6) |
600 mg/kg IV (6) |
Yes |
42 days |
|
|
ticarcillin |
20-24 gm IV (4-6) |
600 mg/kg IV (6-8) |
Yes |
42 days |
|
Meningitis |
cefepime |
6gm IV (8) |
150 mg/kg IV (8) |
+/- gentamicin |
21 days |
|
|
ceftazidime |
6gm IV (8) |
150 mg/kg (8) |
+/- gentamicin |
21 days |
|
|
ciprofloxacin |
800-1200 mg IV (8-12) |
30 mg/kg IV (12) |
+/- gentamicin |
21 days |
|
|
meropenem |
6gm IV (8) |
120 mg/kg IV (8) |
+/- gentamicin |
21 days |
|
Urinary Tract Infection |
ciprofloxacin |
500 mg po (12) |
30 mg/kg po (12) |
No (unless urosepsis) |
7-10 days as out patient |
*Dose in neonates may need to be adjusted
** Consider continuous infusion (see Table 1 for dosing)
Note: Doses in renal failure may need to be adjusted
PO=Oral; gm=gram; mg= milligram; kg=kilogram
Table 4: Doses of IV Aminogylcosides in Specific Infections [Total Daily Dose (Dosing Interval in Hours)]
|
Infection |
Aminoglycoside |
Adult Dose |
Pediatric Dose * |
Peak (P), Trough (T) Recommended in mcg/ ml |
|
Cystic Fibrosis |
amikacin |
15-30 mg/kg (8-12) |
30 mg/kg (8) |
P 20-30, T 5-10 |
|
|
tobramycin |
3.3 mg/kg (8) or 10-12 mg/ kg (24) |
3.3 mg/kg (8) or 10-12 mg/ kg (24) |
P10-12 & T 1-2 for q 8hrs; T <1 once daily dosing & P 10 times MIC |
|
Endocarditis |
tobramycin |
2 mg/ kg load then 5-8 mg/kg (8) or 8-10 mg/kg (24) |
7.5 mg/kg (8) or 7-10 mg/kg (24) |
P10-12 & T 1-2 for q 8hrs; T <1 once daily dosing & P 10 times MIC |
|
|
gentamicin |
2 mg/kg load then 5-8 mg/kg (8) or 7 mg/kg (24) |
7.5 mg/kg (8) or 7 mg/kg (24) |
P 20-30, T 5-10 for q 8hr; T<1 once daily dosing |
|
Meningitis |
amikacin |
15 mg/kg (8) |
15-22.5 mg/kg (8) |
P 20-30, T 5-10 |
|
|
gentamicin |
5 mg/kg (8) |
7.5 mg/kg (8) |
P 6-10, T <2 |
|
|
tobramycin |
5 mg/kg (8) |
7.5 mg/kg (8) |
P 8-10, T <2 |
|
Sepsis |
amikacin |
7.5 mg/kg (12) or 15 mg/kg (24) |
15-30 mg/kg (8) |
P 15-30, T 5-10 for q8; P 56-64, T <1 once daily dosing |
|
|
gentamicin |
2 mg/ kg load then 5 mg/kg (8) or 7 mg/kg (24) |
7.5 mg/kg (8) or 7 mg/kg (24) |
P 20-30, T 5-10 for q 8hr; T<1 once daily dosing |
|
|
tobramycin |
2 mg/ kg load then 5 mg/kg (8) or 7 mg/kg (24) |
7.5 mg/kg (8) or 7-10 mg/kg (24) |
P 6-10, T <2 for q8h; T <1 once daily dosing |
*Dose in neonates may need to be adjusted
Note: Doses in renal failure may need to be adjusted
gm=gram; mg= milligram; kg=kilogram; MIC= minimum inhibatory concentration
Table 5: Recommended Dosages of Antimicrobial Agents Given by the Intraventricular Route
|
Antimicrobial Agent |
Daily Intraventricular Dose, mg |
Comments |
|
amikacin |
5-50 |
Usual daily dose is 30 mg |
|
colistin |
10 |
|
|
gentamicin |
1-8 |
Usual daily dose is 1-2 mg for infants and children; 4-8 mg for adults. |
|
tobramycin |
5-20 |
|
mg= milligram
Figure 1: Approach to Antipseudomonal Antibiotic Therapy for ICU Pneumonia: Empiric Therapy
Figure 2: Day 3: Evaluation for Antipseudomonal Antibiotic Therapy in ICU Pneumonia
