Alternatives to anti-pneumococcal beta-lactams for the empiric treatment of Pseudomonas inpatients with AECOPD

Alternatives to anti-pneumococcal beta-lactams for the empiric treatment of Pseudomonas inpatients with AECOPD

Antibiotic or antibiotic class	Comment
Ciprofloxacin	Active against Pseudomonas but does not have strong activity against Streptococcus pneumoniae and Moraxella catarrhalis, which are also common causes of COPD exacerbations One of the few oral agents with anti-pseudomonal activity, thus, use is often reserved for the outpatient setting
Aztreonam	Lacks activity against S. pneumoniae and other gram-positive pathogens Resistance to aztreonam among pseudomonal isolates is also common
Anti-pseudomonal carbapenems (eg, meropenem, doripenem)	Active against Pseudomonas and other common COPD pathogens Spectrum of activity often broader than necessary
Aminoglycosides (eg, tobramycin, gentamicin, amikacin, plazomicin)	Active against Pseudomonas aeruginosa but generally not used as single agents because of inadequate clinical efficacy

For patients who cannot tolerate anti-pneumococcal beta-lactams (eg, cefepime, piperacillin-tazobactam), alternatives include ciprofloxacin, aztreonam, certain carbapenems, and aminoglycosides. Each comes with relative disadvantages when compared with the anti-pseudomonal beta-lactams. We generally select among them based on local epidemiology, prior susceptibility testing results, drug interactions, and patient comorbidities or intolerances. For empiric treatment, two agents are often needed. The treatment of Pseudomonas is discussed in detail in the UpToDate text.

AECOPD: acute exacerbation of chronic obstructive pulmonary disease.

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Alternatives to anti-pneumococcal beta-lactams for the empiric treatment of Pseudomonas inpatients with AECOPD