Hi all
May I ask whether there is any data that pits these two against each others in term of collateral damage
Reason for asking: say you are faced with a lactose fermentor bacteremia
and the results than show:
R to ampicillin
S to ceftriaxone and pip tazobactam
And the patient is on carbapenem for 3 days and now better clinically
the source: perhaps lung
What would you do?
Would you downgrade to pip tax/ ceftriaxone or it does not matter?
If it matters, can someone lead me to a specific papers that pit these 2 in term of collateral damage
Hi Helmi,
if with collateral damage you mean side effects, both antibiotics are quite safe antibiotics. The susceptibility profile you report does not suggest any of the most usual non-fermenter Gram negatives (Pseudomonas, Acinetobacter, Stenotrophomonas), and having accurate identification would help. Anyway, de-escalating antibiotic treatment when beta-lactams other than carbapenems are active is a good measure having in account the current spread of carbapenemase-producing microorganisms.
I hope the free article at following link will help you, plz check out.
Regards
http://www.trialsjournal.com/content/16/1/24
Juan Luis Muñoz Bellido and Robert Mokszycki are both right, also is very interesting what Bhoj R Singh said. I wish to add another thing which is: consider even if the bacterial strain is capsulated or not. The capsule, can also be a very hard resistance mechanism. This makes even more crucial to know what bacterial strain did you have.
Other important thing is: have you considered the MIC? You should use the more distant MIC possible from the antibiotic's break-point for each (TZP and CRO), if you have the chance to know the MIC.
Anyway, from personal experience, I would use Pipera/tazo, against gram negative fermentant.
Greetings.
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