Best Medication for Pseudomonas Due to Breast Implants?

Question

Which medication is better for pseudomonas due to breast implants? Is it Levaquin or Cipro?

Brent Moelleken, MD · Answer

Presumably, your breast implants are out already.  the prognosis for breast implants with an active infection is poor, since the implants and the tissue surrounding them has no natural defenses.  Infections treated "halfway" for a long period of time lead to scarred and deformed breasts that cannot be fixed by any technique.
Since you know the problem is due to Pseudomonas aeruginosa, you will already have obtained culture results from the laboratory; these sensitivities will guide the therapy.  This is best done by combining the expertise of your plastic surgeon and an infectious disease specialist.
Dr. Rand is absolutely right in that no infection of significant magnitude can be cured unless the area of the infection is properly drained.

Otto Joseph Placik, MD · Answer

Some physicians would argue that the best treatment for a breast implant infection is to remove it and allow the soft tissues to heal and infection to resolve followed by delayed insertion of a new implant 4-6 months later.
After I did a brief review of the literature, it appears that they are considered roughly equivalent in treatment. However, there are several issues that need to be addressed.
The most important factor is to culture the specimens and perform studies that will reveal the sensitivty of your partcular pseudomonas strain. This will guide antimicrobial therapy. Furthermore both Cipro and Levaquin are in the same class of antibiotics called Fluoroquinolones. Some physicians would advise double coverage in case of a serious infection;  this means two antibiotics from different drug classes. Again, this second antibiotic would likely be based on wound cultures.
I hope this helps.

Steven H. Williams, MD · Answer

Thanks for your question -
Breast implant infections are serious and can require oral antibiotics, IV antibiotics or additional surgery including removing the implants.  Implants of course themselves do not cause Pseudomonas infection but can become colonized with the bacteria.
Implants (breast and otherwise) require particular attention to suspected infection because as a foreign material they are significantly more susceptible to infection than your normal tissue.
Ciprofloxacin (INN) is a synthetic antimicrobial agent used to treat severe and life threatening bacterial infections. Ciprofloxacin is commonly referred to as a fluoroquinolone (or quinolone) drug and is a member of the fluoroquinolone class of antibacterials.
Levaquin is also a flurooquinolone (considered 3rd generation).
Levaquin and Ciprofloxacin are broad-spectrum antibiotics that are active against both Gram-positive and Gram-negative bacteria. (Pseudomonas is a gram negative rod).  It functions by inhibiting DNA gyrase, a type II topoisomerase, and topoisomerase IV, which is are enzymes necessary to separate replicated DNA.  If the replicated DNA can't be separated then cell division is inhibited.  If cell division is inhibited the bacteria cannot reproduce. 
So the medications you're asking about, Cipro and Levaquin, work in the same way.

As with any medication there are contraindications, allergies and sensitivities that must be individualized.  In addition there have been bacterial resistance to either or both medication.  The answer depends on the clinical scenario.
I hope this helps.

Steven Wallach, MD · Answer

If you have an implant infection, then I would suggest seeing your doctor and having your implants removed. You may need to be hospitalized for IV antibiotics based upon the cultures results.

Scott E. Kasden, MD, FACS · Answer

If you have pseudomonas infecting your implants, you should have the implants removed or the antibiotic will likely be ineffective. If the infection is arrested, you will likely have significant contractures. A consultation with an infection doctor would be stoungly urged.

George J. Beraka, MD (retired) · Answer

To nurse101,
Hi.  This sounds serious.  We all get an occasional infected implant, unfortunately.  As soon as I have any suspicion that an implant might be infected, I bring in an infectious diseases consultant to help me manage the patient.  There is too much at stake, and too many antibiotics (and other treatments) for a plastic surgeon to be an expert on.
If you have an implant really infected with Pseudomonas, the main treatment is not antibiotics.
1)The implant needs to be removed.
2) The implant cavity needs to be curetted.
3) A suction drain needs to be inserted for one week.
4) You need to wait 6 months before re-inserting the implant.
If these things are done, you would probably get better even without antibiotics.  Having said that, of course you also want to be on the right antibiotic.

Richard P. Rand, MD, FACS (retired) · Answer

Please see Dr. Williams excellent summary of the pharmacology and potential antibiotic use for this infection. To me, I would need to know if the implants are in or out. If they are in and you have a pseudomonas infection of the implant, the implant will need to come out. Antibiotics won't cure it. If they are already out, make sure the pocket is well drained and use an antibiotic culture specific for the infection. Good luck!

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