Antibacterial Therapy Betalactam plus aminoglycoside therapy

Such combinations have been used for empiric therapy for decades.13 The beta-lactams chosen may be higher-generation penicillins (piperacillin, ticarcillin, mezlocillin, piperacillin-tazobactam, or ticarcillin-clavulanate) or higher-generation cephalosporins (cef-tazidime or cefepime) with antipseudomonal activity. Doses should be in the high end of the dosing range. Aminoglycosides include gentamicin, tobramycin, and amikacin, used either with traditional dosing or more recently with single-daily dosing.12 Advantages to this strategy include synergy against organisms such as Pseudomonas, and broad-spectrum activity, especially at centers with marked antimicrobial resistance. Disadvantages include the toxicities of amino-glycosides (nephrotoxicity, ototoxicity, and vestibular toxicity.) Measurement of serum trough levels is important, with dose adjustment whenever renal function changes.

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