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Stenotrophomonas maltophilia therapy

Question
Dear Sirs,

How can Stenotrophomonas maltophilia be treated effectively without inducing resistance?

Answer
Hello,

Stenotrophomonas maltophilia is, like Pseudomonas aeruginosa, a Gram-negative bacteria. As a general rule (but there is no clear data to support an general consensus on this), it is only treated if a clinical correlate exists (disorders, exacerbation of the findings). The germ is inherently multiresistant and therefore, in case of a treatment, the therapy should be a combined antibiotic therapy after susceptibility testing. The combination of Trimethoprim-Sulfamethoxazol with Ticarcillin/Clavulanic acid (or Piperacillin-Tazobactam) shows a good efficacy, as those drugs have benn shown to be the most acitve single drugs in vitro. However, more studies are needed to define concrete therapy regimen.
(European guidelines: Döring et al. 2004, "Early intervention and prevention of lung disease in cystic fibrosis: a European consensus; American guidelines: Gibson et al. 2003 "Pathophysiology and Management of Pulmonary Infections in CF").

Best regards,
Dr. C. Smaczny
09.07.2008