Use of third-generation cephalosporins. Pseudomonas

Although the frequency of infection with P. aeruginosa has declined in many centers treating neutropenic patients with cancer, infections still occur and can be accompanied by considerable morbidity and mortality. Furthermore, patterns of infection can change again, and Pseudomonas may reemerge. Thus, in high-risk, immunocompromised patients, adequate bacterial coverage for P. aeruginosa should be part of any empiric regimen. Third-generation cephalosporins are an important part of the therapeutic armamentarium for the empiric management of neutropenic patients. Assuming a low level of resistance at a given center, however, only ceftazidime and cefoperazone possess sufficient antipseudomonal activity to be used for monotherapy. If other third-generation cephalosporins are used, it is imperative that an aminoglycoside or an antipseudomonal penicillin be added. But even when combined with an aminoglycoside, ceftriaxone would not be a good choice for neutropenic patients. It is an important agent in non-neutropenic hosts or in other immunocompromised patients in whom infection with Pseudomonas is unlikely to occur.