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Treatment of CRAB

Source

  • The use of high-dose ampicillin-sulbactam (total daily dose of 6–9 g of the sulbactam component) in combination with at least 1 other agent is suggested for the treatment of CRAB infections.

  • Combination therapy with at least 2 active agents, whenever possible, is suggested for the treatment of CRAB infections, at least until clinical improvement is observed, because of the limited clinical data supporting any single antibiotic agent.

  • High-dose ampicillin-sulbactam is suggested as a component of combination therapy for CRAB, regardless of whether susceptibility has been demonstrated.

  • Polymyxin B can be considered in combination with at least 1 other agent for the treatment of CRAB infections.

  • High-dose minocycline or high-dose tigecycline can be considered in combination with at least 1 other agent for the treatment of CRAB infections. The panel prefers minocycline because of the long-standing clinical experience with this agent and the availability of CLSI susceptibility interpretive criteria; however, tigecycline is also a reasonable option.

  • Cefiderocol should be limited to the treatment of CRAB infections refractory to other antibiotics or in cases where intolerance or resistance to other agents precludes their use. When cefiderocol is used to treat CRAB infections, the panel suggests prescribing the agent as part of a combination regimen.

  • High-dose, extended-infusion meropenem or imipenem-cilastatin are not suggested for the treatment of CRAB infections.