Carbapenem-resistant organisms: Difference between revisions
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**[[Imipenem-relebactam]] |
**[[Imipenem-relebactam]] |
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+ | === Dosing === |
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+ | {| class="wikitable" |
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+ | !Antimicrobial |
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+ | !Dose |
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+ | !Targetted Organisms |
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+ | |- |
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+ | |[[amikacin]] |
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+ | |20 mg/kg IV load then per PK monitoring |
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+ | [[Cystitis]]: 15 mg/kg IV once |
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+ | |ESBL-E, AmpC-E, CRE, DTR-PA |
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+ | |- |
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+ | |[[ampicillin-sulbactam]] |
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+ | |9 g IV q8h infused over 4 h, or 27 g IV over 24 hours continuous infusion |
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+ | |CRAB |
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+ | |- |
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+ | |[[cefepime]] |
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+ | |2 g IV q8h infused over 2 h |
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+ | [[Cystitis]]: 1 g IV q8h |
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+ | |AmpC-E |
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+ | |- |
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+ | |[[cefiderocol]] |
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+ | |2 g IV q8h infused over 3 h |
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+ | |CRE, DTR-PA, CRAB, Stenotrophomonas |
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+ | |- |
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+ | |[[ceftazidime-avibactam]] |
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+ | |2.5 g IV q8h infused over 3 h |
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+ | |CRE, DTR-PA |
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+ | |- |
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+ | |[[ceftazidime-avibactam]] plus [[aztreonam]] |
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+ | |2.5 g IV q8h infused over 3 h plus 2 g IV q8h infused over 3 h, infused concurrently if possible |
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+ | |MBL CRE, Stenotrophomonas |
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+ | |- |
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+ | |[[ceftolozane-tazobactam]] |
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+ | |3 g IV q8h infused over 3 h |
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+ | [[Cystitis]]: 1.5 g IV q8h infused over 1 h |
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+ | |DTR-PA |
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+ | |- |
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+ | |[[ciprofloxacin]] |
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+ | |400 mg IV q8-12h or 500-750 mg p.o. q12h |
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+ | |ESBL-E, AmpC-E |
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+ | |- |
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+ | |[[colistin]] |
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+ | | |
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+ | |CRE cystitis, DTR-PA cystitis, CRAB cystitis |
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+ | |- |
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+ | |[[eravacycline]] |
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+ | |1 mg/kg IV q12h |
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+ | |CRE, CRAB |
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+ | |- |
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+ | |[[ertapenem]] |
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+ | |1 g IV q24h infused over 30 min |
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+ | |ESBL-E, AmpC-E |
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+ | |- |
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+ | |[[fosfomycin]] |
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+ | |[[Cystitis]]: 3 g p.o. once |
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+ | |ESBL-E. coli cystitis |
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+ | |- |
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+ | |[[gentamicin]] |
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+ | |7 mg/kg IV load then based on PK |
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+ | [[Cystitis]]: 5 mg/kg IV once |
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+ | |ESBL-E, AmpC-, CRE, DTR-PA |
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+ | |- |
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+ | |[[imipenem-cilastatin]] |
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+ | |ESBL-E or AmpC-E: 500 mg IV q6h infused over 30 min |
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+ | CRE and CRAB: 500 mg IV q6h infused over 3 h |
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+ | [[Cystitis]]: 500 mg IV q6h infused over 30 min |
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+ | |ESBL-E, AmpC-E, CRE, CRAB |
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+ | |- |
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+ | |[[imipenem-cilastatin-relebactam]] |
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+ | |1.25 g IV q6h infused over 30 min |
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+ | |CRE, DTR-PA |
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+ | |- |
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+ | |[[levofloxacin]] |
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+ | |750 mg p.o./IV q24h |
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+ | |ESBL-E, AmpC-E, Stenotrophomonas |
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+ | |- |
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+ | |[[meropenem]] |
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+ | |ESBL-E or AmpC-E: 1-2 g IV q8h infused over 30 min |
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+ | CRE and CRAB: 2 g IV q8h infused over 30 min |
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+ | [[Cystitis]]: 1 g IV q8h, infused over 30 min |
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+ | |ESBL-E, AmpC-E, CRE, CRAB |
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+ | |- |
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+ | |[[meropenem-vaborbactam]] |
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+ | |4 g IV q8h infused over 3 h |
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+ | |CRE |
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+ | |- |
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+ | |[[minocycline]] |
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+ | |200 mg IV/p.o. q12h |
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+ | |CRAB, Stenotrophomonas |
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+ | |- |
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+ | |[[nitrofurantoin]] |
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+ | |cystitis: macrocystals 100 mg p.o. q12h or oral suspension 50 mg p.o. q6h |
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+ | |ESBL-E cystitis, AmpC-E cystitis |
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+ | |- |
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+ | |[[plazomicin]] |
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+ | |15 mg/kg IV load then dosed by PK |
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+ | [[Cystitis]]: 15 mg/kg IV once |
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+ | |ESBL-E, AmpC-E, CRE, DTR-PA |
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+ | |- |
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+ | |[[polymyxin B]] |
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+ | | |
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+ | |DTR-PA, CRAB |
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+ | |- |
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+ | |[[tigecycline]] |
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+ | |200 mg IV load followed by 100 mg IV q12h |
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+ | |CRE, CRAB, Stenotrophomonas |
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+ | |- |
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+ | |[[tobramycin]] |
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+ | |7 mg/kg IV load then dosed by PK |
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+ | [[Cystitis]]: 5 mg/kg IV once |
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+ | |ESBL-E, AmpC-E, CRE, DTR-PA |
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+ | |- |
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+ | |[[co-trimoxazole]] |
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+ | |8-12 mg/kg/day (TMP) p.o./IV divided 18-12h |
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+ | [[Cystitis]]: 160 mg (TMP) p.o./IV q12h |
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+ | |ESBL-E, AmpC-E, Stenotrophomonas |
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+ | |} |
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[[Category:Bacteria]] |
[[Category:Bacteria]] |
Revision as of 08:42, 30 August 2022
Background
- Mechanisms include decreased expression of porins, increased expression of efflux pumps, and carbapenemases
Management
Antibiotic | KPC | NDM | OXA-48 | CRPsA | CRAcB | Stenotrophomonas |
---|---|---|---|---|---|---|
aztreonam-avibactam | + | + | + | ± | – | + |
cefiderocol | + | + | + | + | + | + |
ceftazidime-avibactam | + | – | + | ± | – | – |
ceftolozane-tazobactam | – | – | – | ± | – | ± |
eravacycline | + | + | + | – | + | + |
fosfomycin | ± | ± | ± | ± | – | – |
imipenem-relebactam | + | – | ± | + | – | – |
meropenem-vaborbactam | + | – | – | – | – | – |
plazomicin | + | ± | + | ± | – | – |
colistin | ± | ± | ± | ± | ± | ± |
tigecycline | + | + | + | – | + | + |
- For KPC, the most common Class A carbapenemase, consider:
- For AmpCs, consider:
- For metallo-β-lactamases, consider:
- For all of the above, also consider:
- Eravacycline
- Tigecycline
- Colistin, though increasing resistance
- Plazomicin
- For carbapenem-resistant Pseudomonas aeruginosa, consider:
Dosing
Antimicrobial | Dose | Targetted Organisms |
---|---|---|
amikacin | 20 mg/kg IV load then per PK monitoring
Cystitis: 15 mg/kg IV once |
ESBL-E, AmpC-E, CRE, DTR-PA |
ampicillin-sulbactam | 9 g IV q8h infused over 4 h, or 27 g IV over 24 hours continuous infusion | CRAB |
cefepime | 2 g IV q8h infused over 2 h
Cystitis: 1 g IV q8h |
AmpC-E |
cefiderocol | 2 g IV q8h infused over 3 h | CRE, DTR-PA, CRAB, Stenotrophomonas |
ceftazidime-avibactam | 2.5 g IV q8h infused over 3 h | CRE, DTR-PA |
ceftazidime-avibactam plus aztreonam | 2.5 g IV q8h infused over 3 h plus 2 g IV q8h infused over 3 h, infused concurrently if possible | MBL CRE, Stenotrophomonas |
ceftolozane-tazobactam | 3 g IV q8h infused over 3 h
Cystitis: 1.5 g IV q8h infused over 1 h |
DTR-PA |
ciprofloxacin | 400 mg IV q8-12h or 500-750 mg p.o. q12h | ESBL-E, AmpC-E |
colistin | CRE cystitis, DTR-PA cystitis, CRAB cystitis | |
eravacycline | 1 mg/kg IV q12h | CRE, CRAB |
ertapenem | 1 g IV q24h infused over 30 min | ESBL-E, AmpC-E |
fosfomycin | Cystitis: 3 g p.o. once | ESBL-E. coli cystitis |
gentamicin | 7 mg/kg IV load then based on PK
Cystitis: 5 mg/kg IV once |
ESBL-E, AmpC-, CRE, DTR-PA |
imipenem-cilastatin | ESBL-E or AmpC-E: 500 mg IV q6h infused over 30 min
CRE and CRAB: 500 mg IV q6h infused over 3 h Cystitis: 500 mg IV q6h infused over 30 min |
ESBL-E, AmpC-E, CRE, CRAB |
imipenem-cilastatin-relebactam | 1.25 g IV q6h infused over 30 min | CRE, DTR-PA |
levofloxacin | 750 mg p.o./IV q24h | ESBL-E, AmpC-E, Stenotrophomonas |
meropenem | ESBL-E or AmpC-E: 1-2 g IV q8h infused over 30 min
CRE and CRAB: 2 g IV q8h infused over 30 min Cystitis: 1 g IV q8h, infused over 30 min |
ESBL-E, AmpC-E, CRE, CRAB |
meropenem-vaborbactam | 4 g IV q8h infused over 3 h | CRE |
minocycline | 200 mg IV/p.o. q12h | CRAB, Stenotrophomonas |
nitrofurantoin | cystitis: macrocystals 100 mg p.o. q12h or oral suspension 50 mg p.o. q6h | ESBL-E cystitis, AmpC-E cystitis |
plazomicin | 15 mg/kg IV load then dosed by PK
Cystitis: 15 mg/kg IV once |
ESBL-E, AmpC-E, CRE, DTR-PA |
polymyxin B | DTR-PA, CRAB | |
tigecycline | 200 mg IV load followed by 100 mg IV q12h | CRE, CRAB, Stenotrophomonas |
tobramycin | 7 mg/kg IV load then dosed by PK
Cystitis: 5 mg/kg IV once |
ESBL-E, AmpC-E, CRE, DTR-PA |
co-trimoxazole | 8-12 mg/kg/day (TMP) p.o./IV divided 18-12h
Cystitis: 160 mg (TMP) p.o./IV q12h |
ESBL-E, AmpC-E, Stenotrophomonas |