Summary recommendations for specific antibiotics in treatment of carbapenemase producing Enterobacterales
| Antibiotics | Recommendation | Effective CPE type |
|---|---|---|
| Polymyxins (including colistin) | If meropenem MIC≤8 mg/L, combination therapy with meropenem | KPC, NDM, OXA-48 |
| If meropenem MIC>8 and ≤32 mg/L, combination with tigecycline or aminoglycosides etc | ||
| Tigecycline | Combination therapy of MDR Enterobacteriaceae including CPE, use of higher dosing | KPC, NDM, OXA-48 |
| Fosfomycin | Combination therapy of MDR Enterobacteriaceae including CPE, lower UTI | KPC, NDM, OXA-48 |
| Gentamicin | Combination therapy of gentamicin-susceptible KPC-producing CPE | KPC |
| Imipenem/meropenem | If meropenem MIC≤8 mg/L, combination therapy with polymyxin | KPC, NDM, OXA-48 |
| Double carbapenem therapy: ertapenem and meropenem | ||
| Ceftazidime/avibactam | Alone or combination with carbapenem or colistin in class A, D CPE | KPC, OXA-48 |
| Meropenem/vaborbactam | Alone or combination with colistin or tigecycline in KPC | KPC |
| Aztreonam/avibactam | Combination with colistin or tigecycline in class B (MBL) | NDM |
| Plazomicin | Combination with colistin or tigecycline in KPC (not MBL) | KPC |
| Ceftazidime | OXA-48 producers are susceptible if not ESBL or AmpC producers | OXA-48 |
