Stenotrophomonas Maltophilia Medication

Updated: Sep 16, 2021
  • Author: Sara Ahmed, MBBS, FCPS, MRCP(UK); Chief Editor: Michael Stuart Bronze, MD  more...
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Medication Summary

Because S maltophilia is predominantly a colonizer, antimicrobial treatment may be unnecessary and may be potentially harmful. Thus, determination of whether the organism is truly the cause of an infection is necessary to determine the need for antibiotic therapy.

As a general principle, colonization should not be treated with antimicrobial therapy.

S maltophilia, is usually resistant to aminoglycosides, antipseudomonal penicillins, and cephalosporins. S maltophilia is consistently susceptible to trimethoprim-sulfamethoxazole (TMP-SMZ) and is a drug of choice. [26, 27] If TMP-SMZ cannot be used, the organism is usually sensitive to doxycycline, minocycline, respiratory quinolones,or ceftazidime. [28, 29]  Tigecycline may potentially be helpful, but clinical investigation is needed. [26, 30, 31]  Polymyxin B/Colistin may be effective, at least in vitro, though not without frequent adverse effects. [32, 33]

Studies have demonstrated activity of Eravacyclines and Omadacycline in vitro but further studies are required to ascertain the clinical efficacy and potential therapeutic option for multidrug-resistant S maltophilia infections. [34, 35, 36, 37, 38]

Cefiderocol demonstrated activity in vitro however it was found to be resistant in clinical isolates.

The combination of aztreonam with ceftazidime/avibactam has been successfully used for the treatment of a persistent S maltophilia bacteremia in a renal transplant patient. [39]  This synergistic combination suggests a potential therapeutic option for multidrug resistant S maltophilia infections.



Class Summary

Therapy should be selective to avoid covering multiple isolates from a body site in the context of the clinical setting.

Sulfamethoxazole/trimethoprim (Bactrim, Bactrim DS, Septra, Septra DS)

Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Antibacterial activity includes common urinary tract pathogens, except P aeruginosa.

Cefepime (Maxipime)

Fourth-generation cephalosporin with good gram-negative coverage, similar to ceftazidime, but better gram-positive coverage.

Minocycline (Dynacin, Minocin)

Treats infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Chlamydia, Rickettsia, and Mycoplasma.

Tigecycline (Tygacil)

A glycylcycline antibiotic that is structurally similar to tetracycline antibiotics. Inhibits bacterial protein translation by binding to 30S ribosomal subunit, and blocks entry of amino-acyl tRNA molecules in ribosome A site. Indicated for complicated skin and skin structure infections caused by E coli, E faecalis (vancomycin-susceptible isolates only), S aureus (methicillin-susceptible and -resistant isolates), S agalactiae, S anginosus group (includes S anginosus, S intermedius, and S constellatus), S pyogenes, and B fragilis.