Treatment Options

1. High dose ampicillin-sulbactam (if susceptible) – in combination with another agent. If not available, cefoperazone-sulbactam (1g/1g) may be used instead.
2. Polymyxins (do-not use polymyxin B for UTI)
3. Minocycline
4. Tigecycline (do not use for UTI)
5. Sulbactam in combination with another agent
6. Other agents like trimethoprim-sulfamethoxazole, aminoglycosides, if susceptible

    Use of these agents as standalone therapy or in combination is a matter of debate.

• Combination therapy with at least two active agents (include high dose ampicillin-sulbactam even if non-susceptible), whenever possible, is suggested for the treatment of moderate to severe CRAB infections
• A single active agent may be considered for the treatment of patients with mild CRAB infections.  Mild infections although maybe difficult to define, but may include urinary tract infection or, skin and soft tissue infections without hemodynamic instability. The agent of choice is ampicillin -sulbactam due to sulbactam’s activity against CRAB demonstrated in-vitro. It is useful to note that even if non-susceptibility to ampicillin-sulbactam is demonstrated, high dose ampicilllin sulbactam may still be an effective option.