Hospitalized Adults: Respiratory Tract Infections: Healthcare-Associated Pneumonia

PrintPrintPDFPDF

Doses provided in this table are for patients with normal renal and hepatic function. Click on drug link to go to dosing guidelines.  Some antimicrobials are restricted (ID-R).  Click on link for guidelines on obtaining authorization.

Diagnosis

Common Pathogens

Drug(s) of First Choice

Alternative Drug(s)

Comments

Healthcare –associated pneumonia (HCAP):

acquired in long-term care facility where antimicrobials used or Pseudomonas risk factors (see Comments)

 

S.aureus

S.pneumoniae

H.influenzae

 

Antibiotic sensitive enteric gram negative bacilli:

E. coli

Enterobacter aerogenes

Klebsiella pneumoniae

Proteus mirabilis

Serratia marcesans

P. aeruginosa (if risk factors present)

Hemodynamically stable & no Pseudomonas risk factors

Vancomycin

PLUS one of:

Ertapenem 1 g IV daily

WITH OR WITHOUT one of*:

Doxycycline 100 mg IV/PO BID

OR

Levofloxacin 750 mg IV/PO daily

 

Hemodynamically unstable or Pseudomonas risk factors

Vancomycin

PLUS one of:

Piperacillin/tazobactamID-R: SFGH 4.5 g IV q6h

OR

CefepimeID-R: SFGH VASF 2 g IV q8h-q12h

WITH OR WITHOUT*:

Azithromycin 500 mg IV daily

For severe PCN allergy:

Vancomycin

PLUS one of:

AztreonamID-R: SFGH 2 g IV q8h

WITH OR WITHOUT one of*:

Doxycycline 100 mg IV/PO BID

OR

Azithromycin 500 mg IV daily

Pseudomonas risk factors include: structural lung disease, repeated exacerbations of severe COPD leading to frequent steroid and/or antibiotic use, recent mechanical ventilation, recent prior exposure to broad-spectrum antibiotics.

 

Avoid using levofloxacin if the patient has recently been treated with a fluoroquinolone.

 

*For patients admitted from the community with HCAP and not treated with levofloxacin, consider  adding atypical coverage with doxycycline (floor patients) or azithromycin (ICU patients).