eMedicine Specialties > Infectious Diseases > Bacterial Infections
Serratia: Treatment & Medication
Updated: Nov 4, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
Antibiotic therapy is the primary treatment in most patients with Serratia infection. Home therapy is an option in patients who are clinically stable.
Surgical Care
Purulent collections (abscesses) may require drainage.
Consultations
- Consult a cardiac surgeon if considering valve replacement in patients with infective endocarditis.
- In a possible nosocomial outbreak of Serratia infection, strain typing may assist the epidemiologic investigation.
Medication
S marcescens is naturally resistant to ampicillin, macrolides, and first-generation cephalosporins. In Taiwan, 92% of the strains are resistant to cefotaxime, but 99% are still susceptible to ceftazidime. Extended spectrum beta-lactamases are produced by most S marcescens strains.13
Serratia infections should be treated with an aminoglycoside plus an antipseudomonal beta-lactam, as the single use of a beta-lactam can select for resistant strains. Most strains are susceptible to amikacin, but reports indicate increasing resistance to gentamicin and tobramycin. Quinolones also are highly active against most strains.
Definitive therapy should be based on the results of susceptibility testing because multiresistant strains are common.
Antibiotics
Empiric antimicrobial therapy should cover all likely pathogens in the context of the clinical setting.
Levofloxacin (Levaquin)
For pseudomonal infections and infections due to multidrug-resistant gram-negative organisms.
Adult
500 mg PO qd for 7-14 d
Pediatric
<18 years: Not recommended
>18 years: Administer as in adults
Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; levofloxacin reduces therapeutic effects of phenytoin; probenecid may increase levofloxacin serum concentrations
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy
Cefepime (Maxipime)
Fourth-generation cephalosporin. Gram-negative coverage comparable to ceftazidime but has better gram-positive coverage (comparable to ceftriaxone). Cefepime is a zwitter ion; rapidly penetrates gram-negative cells. Best beta-lactam for IM administration. Poor capacity to cross blood-brain barrier precludes use for treatment of meningitis.
Adult
Mild-to-moderate infection: 1-2 g IV q12h for 5-10 d
Severe infection (eg, pseudomonal, neutropenic fever): 2 g IV q8h
Pediatric
<2 months: Not established
2 months to 16 years (<40 kg): 50 mg/kg IV q8h; not to exceed 2 g
>16 years or >40 kg: Administer as in adults
Probenecid may increase effects of cefepime; aminoglycosides increase the nephrotoxic potential of cefepime
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Dosage adjustments (adult adjustments)
CrCl (mL/min) 80-50: 0.5-2 g q12-24h
CrCl 50-10: 0.5-2 g/d
CrCl <10: 0.25-0.5 g/d
HD: as for CrCl <10, with an extra 0.25 g after HD
During peritoneal dialysis: 1-2 g q48h
High doses may cause CNS toxicity; prolonged use of cefepime may predispose patients to superinfection
Ertapenem (Invanz)
Bactericidal activity results from inhibition of cell wall synthesis and is mediated through ertapenem binding to penicillin-binding proteins. Stable against hydrolysis by various beta-lactamases including penicillinases, cephalosporinases, and extended-spectrum beta-lactamases. Hydrolyzed by metallo-beta-lactamases.
Adult
1 g qd for 14 d if IV and 7 d if IM; infuse over 30 min if IV
CrCl <30 mL/min/1.73 m2: 500 mg IV qd
Pediatric
<3 months: Not established
3 months to 12 years: 15 mg/kg IV q12h; not to exceed 1 g/d
>12 years: Administer as in adults
Probenecid may reduce renal clearance of ertapenem and increase half-life but benefit is minimum and does not justify coadministration
Documented hypersensitivity to drug or amide type anesthetics
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Pseudomembranous colitis may occur; seizures and CNS adverse reactions may occur; when using with lidocaine to administer intramuscularly, avoid inadvertent injection into blood vessel; decrease dose in renal failure; serious and occasionally fatal hypersensitivity reactions may occur with beta lactams, caution with previous hypersensitivity reactions to penicillin, cephalosporins, other beta lactams, or other allergens; do not mix or coinfuse in same IV line as other medications; do not mix with dextrose containing diluents
Amikacin (Amikin)
Preferred aminoglycoside. Usually synergistic with antipseudomonal beta-lactams. Use both in combination, pending results of susceptibility testing. For gram-negative bacterial coverage of infections resistant to gentamicin and tobramycin. Effective against Pseudomonas aeruginosa. Irreversibly binds to 30S subunit of bacterial ribosomes. Blocks recognition step in protein synthesis. Causes bacterial growth inhibition.
Adult
15 mg/kg/d IV q24h or in a single dose; use adjusted dosing weight, IBW + 0.4 (ABW-IBW), for calculation if actual body weight exceeds IBW by more than 30%
Pediatric
Administer as in adults
Coadministration with other aminoglycosides, penicillins, cephalosporins, and amphotericin B increases nephrotoxicity; enhances effects of neuromuscular blocking agents; causes respiratory depression; irreversible hearing loss may occur with coadministration of loop diuretics
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Not intended for long-term therapy; caution in patients with renal failure (not on dialysis), hypocalcemia, myasthenia gravis, and conditions that depress neuromuscular transmission
Aztreonam (Azactam)
Usually synergistic with amikacin. Use both in combination, pending results of susceptibility testing. A monobactam that inhibits cell wall synthesis during bacterial growth. Active against gram-negative bacilli.
Adult
1-2 g IV q6-8h
Pediatric
90-120 mg/kg/d IV/IM divided q6-8h
Tetracyclines may reduce effects
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal insufficiency
Meropenem (Merrem IV)
Preferred therapy for Serratia meningitis. Bactericidal broad-spectrum carbapenem antibiotic that inhibits cell wall synthesis. Effective against most gram-positive and gram-negative bacteria. Has increased activity against gram-negative bacteria and slightly decreased activity against staphylococci and streptococci compared to imipenem.
Adult
1000 mg IV q8h
Pediatric
40 mg/kg IV q8h
Probenecid may inhibit renal excretion of meropenem, increasing meropenem levels
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dosage in patients with renal insufficiency; pseudomembranous colitis and thrombocytopenia may occur, requiring immediate discontinuation of medication
Imipenem-cilastatin (Primaxin)
Comparable in activity to meropenem.
Adult
Base initial dose on severity of infection and administer in equally divided doses; dose may range from 500-1000 mg IV q6h; not to exceed 4 g/d
Pediatric
<12 years: Not established; 15-25 mg/kg/dose IV q6h suggested for >3 months
>12 years:
Fully susceptible organisms: Not to exceed 2 g/d
Moderately susceptible organisms: Not to exceed 4 g/d
Nephrotoxicity increased with aminoglycoside; coadministration with cyclosporine may increase CNS adverse effects of both agents; coadministration with ganciclovir may result in generalized seizures
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Risk of inducing seizures or cerebral toxicity with 1-g doses; adjust dose in renal insufficiency; avoid use in children <12 y
Ciprofloxacin (Cipro)
Greatest anti-P aeruginosa activity among the quinolones. May be particularly useful for isolates resistant to the aminoglycosides.
Adult
400 mg IV q12h
500-750 mg PO q12h
Pediatric
<18 years: Not recommended
Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; levofloxacin reduces therapeutic effects of phenytoin; probenecid may increase levofloxacin serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy
More on Serratia |
| Overview: Serratia |
| Differential Diagnoses & Workup: Serratia |
 Treatment & Medication: Serratia |
| Follow-up: Serratia |
| References |
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Further Reading
Keywords
infection sepsis, urinary tract infection, UTI, meningitis, cerebral abscess, keratitis parotitis, bacteremia
