AntiMRSA and Antipseudomonal Combination Therapy

Patient Case: AntiMRSA and Antipseudomonal Combination Therapy

A 66 year old with AML and an ANC 200 presents with fever + dyspnea. Chest X-ray reveals a new RLL infiltrate. Port site is also red & tender. He has a history of recent C. difficile but no other MDR infection.

What empiric therapy is best?

A. Vancomycin + Piperacillin/Tazobactam
B. Vancomycin + Cefepime
C. Vancomycin + Meropenem

How did others respond?

Reveal the answer

Best Answer

Vancomycin + Piperacillin/Tazobactam

Explanation: This combination is lower risk for C. difficile relative to other options making it optimal in our patient with a history of C. difficile.

Vancomycin + piperacillin/tazobactam is sometimes avoided due to increased risk of nephrotoxicity but this must be balanced against other risks. Nephrotoxicity rates are similar to other regimens when combo therapy is limited to 72 hours. Therapy can likely be narrowed within this timeframe. If this patient had a history of MDR infection previous cultures might also be used to guide therapy. In this case, the main patient specific consideration is C. difficile risk.

All antimicrobials have associated risks which should be factored into therapeutic decisions. Everyone has a favorite antiMRSA + antipseudomonal combo but remember each one has its merits!

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