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Infective Exacerbations of Bronchiectasis: Known colonisation with Pseudomonas  ​
Causative organisms: Pseudomonas
Review the antibiotic susceptibilities of previous Pseudomonas culture results for susceptibility to the agents below. If previous isolates are resistant to all the antibiotics below or more information is required, please discuss with Medical Microbiology

 
 
First Line
Second Line

Second Line

Allergy status
(Confirm allergy status prior to choosing antimicrobial regime)
 
No penicillin allergy
 
 
Antimicrobial
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Check for interactions
 
Piperacillin/tazobactam
 
Ceftazidime
 
Ciprofloxacin*
Dose
4.5g every 6 hours
2000mg every 8 hours
Ciprofloxacin* 750mg every 12 hours
Route
IV
IV
PO
Duration
14 days
 
Please note if patient has grown pseudomonas in sputum in last 3 months please refer to drug-bug guidance​ for required dose adjustment of piperacillin/tazobactam. 

 
*Ciprofloxacin is ineffective if given with multi-valent cation containing products e.g. antacids, supplements or feeds containing calcium, iron, magnesium, zinc, sucralfate or bismuth. These products bind to the antibiotics and reduce their absorption by up to 90%.
 
If patients are prescribed antacids or supplements containing calcium iron, magnesium zinc or bismuth. It is advised these medications are stopped/withheld for the duration of antibiotic treatment. If this is not possible due to a clinical need, then an alternative antibiotic must be considered
If the antibiotic and a cation containing product must be prescribed together:
·         Administration times should be as far apart as possible
·         Reduce the dosing frequency of the interacting product if possible
·         In the case of oral nutritional supplements, multiple sips throughout the day should be replaced with set administration times to enable adequate spacing from oral antibiotic administration
·         If a patient is receiving an enteral feed tetracyclines and fluoroquinolones should generally be avoided unless there is a specific feed free window