Successful Use of Ceftolozane-Tazobactam to Treat a Pulmonary Exacerbation of Cystic Fibrosis Caused by Multidrug-Resistant Pseudomonas aeruginosa.
Pharmacotherapy. 2016 Aug 13;
Authors: Vickery S, McClain D, Wargo KA
Ceftolozane-tazobactam, a novel β-lactam/β-lactamase inhibitor, was recently approved for the treatment of complicated urinary tract and intraabdominal infections, as monotherapy and in combination with metronidazole, respectively. Ceftolozane-tazobactam exhibits a wide spectrum of activity against both gram-positive bacteria, gram-negative bacteria including multidrug-resistant (MDR) Pseudomonas aeruginosa, and some anaerobic bacteria. Although not currently approved for any pulmonary indication, studies have demonstrated excellent distribution to epithelial lining fluid, indicating that it may be an alternative agent to use in the treatment of respiratory tract infections caused by MDR P. aeruginosa. Unfortunately, data are lacking regarding the use of ceftolozane-tazobactam in the treatment of respiratory tract infections, including patients with cystic fibrosis (CF). We describe the first case report, to our knowledge, of a 25-year-old Caucasian man successfully treated with ceftolozane-tazobactam for a pulmonary exacerbation of his CF caused by MDR P. aeruginosa. He was admitted for his fourth hospitalization in 7 months for a pulmonary exacerbation of his CF. After blood and sputum were cultured, prednisone, cefepime, inhaled tobramycin, and intravenous ciprofloxacin were started. On day 4, after no signs of clinical improvement, respiratory cultures revealed nonmucoid, MDR P. aeruginosa, susceptible to only colistin. β-lactam therapy was subsequently change to ceftolozane-tazobactam 3 g intravenously every 8 hours, while continuing ciprofloxacin and inhaled tobramycin. Ceftolozane-tazobactam susceptibility was determined by Etest method (minimum inhibitory concentration 1.5 μg/mL). By day 3 of therapy, the patient showed signs of clinical improvement and was discharged after completion of a 12-day course of antibiotics. Until additional research is available, we hope that this evidence will provide consideration of ceftolozane-tazobactam for this novel, off-label indication. This article is protected by copyright. All rights reserved.
PMID: 27522066 [PubMed - as supplied by publisher]