Medication Summary
In most cases, Y pseudotuberculosis infections do not require therapy with antimicrobials. However, in younger or immunosuppressed patients who are critically ill, antibiotic therapy may be prudent. Antibiotic therapy is warranted to treat severe Y pseudotuberculosis infection. Guidance via in vitro testing may be helpful; initial empiric therapy may include various antibiotics noted above.
Antibiotics
Class Summary
Therapy must be comprehensive and cover all likely pathogens in the context of the clinical setting.
Tobramycin
Aminoglycoside antibiotic for gram-negative coverage. Used in combination with both an agent against gram-positive organisms and one that covers anaerobes. Dosing regimens are numerous and are adjusted based on CrCl and changes in the volume of distribution.
Gentamicin
Aminoglycoside antibiotic for gram-negative coverage. Used in combination with both an agent against gram-positive organisms and one that covers anaerobes. Dosing regimens are numerous; adjust the dose based on creatinine clearance (CrCl) and changes in volume of distribution.
Trimethoprim/sulfamethoxazole (Bactrim, Bactrim DS)
Sulfamethoxazole inhibits bacterial growth by inhibiting the synthesis of dihydrofolic acid formation from para-aminobenzoic acid. Trimethoprim inhibits enzymes of the folic acid pathway by blocking dihydrofolic acid reduction to tetrahydrofolate.
Ciprofloxacin (Cipro, Cipro XR)
Ciprofloxacin is a fluoroquinolone with activity against pseudomonads, streptococci, methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, and most gram-negative organisms, but with no activity against anaerobes. It inhibits bacterial deoxyribonucleic acid (DNA) synthesis and, consequently, growth.
Ceftriaxone
Ceftriaxone is a third-generation cephalosporin with broad-spectrum, gram-negative activity. It has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms. It arrests bacterial growth by binding to one or more penicillin-binding proteins.
Doxycycline (Acticlate, Adoxa, Doryx, Monodox, Morgidox)
Doxycycline inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. This agent interferes with bacterial cell wall synthesis during active multiplication, causing cell wall death and resultant bactericidal activity against susceptible bacteria.
