An evaluation of antipseudomonal antimicrobic agents

The data summarized above indicate that major strides have been made in the use of beta-lactam antibiotics for serious infections due to P. aeruginosa. Emergence of resistance during therapy is a worrisome feature of the antipseudomonal beta-lactams. It is also disturbing that in no animal model of infection has beta-lactam monotherapy been superior to aminoglycoside monotherapy or the combination of an aminoglycoside with an antipseudomonal penicillin. Imipenem, used alone, has equalled aminoglycoside antibacterial activity in some experimental settings and may be an exception. In most hospitals, aminoglycoside resistance occurs at a low and predictable incidence. Aminoglycoside nephrotoxicity is infrequent, mild in severity, and reversible. The quinolone family appears promising but clinical studies are pending. Based on the available data, it appears that the standard therapy of serious life-threatening infection due to P. aeruginosa remains the combination of an aminoglycoside and an antipseudomonal penicillin.