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 |
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UCSF Parnassus Hospital-acquired pneumonia and Ventilator-associated pneumonia |
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Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) at ZSFG and the VASF For all categories below: -If extensive prior antibiotic exposure: consider vancomycin plus a Gram negative antibiotic which the patient has not recently received; discuss with I.D. or I.D. pharmacy if uncertain -If known colonization with resistant organism(s): consider broader antibiotics to cover known organism(s); discuss with I.D. or I.D. pharmacy if uncertain |
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ZSFGH/VASF Hospital-acquired pneumonia: mild disease (or unclear diagnosis) without extensive prior antibiotic exposure |
S.pneumoniae H.influenzae Possible enteric Gram-negative rods |
Ceftriaxone or Ertapenem or Levofloxacin |
For severe penicillin allergy: Levofloxacin |
Obtain sputum for Gram stain and culture |
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ZSFGH/VASF Hospital-acquired pneumonia: severe disease (severe hypoxemia, multifocal disease, large or loculated pleural effusion, cavitary disease) |
S. pneumoniae H. influenzae Enteric Gram negative rods S. aureus Possible P. aeruginosa |
Vancomycin PLUS ONE OF: Cefepime or Piperacilin/ tazobactam |
For severe PCN allergy: PLUS
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Obtain sputum for Gram stain and culture
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ZSFG/VASF
Ventilator-associated pneumonia: intubated < 5 days without complicated disease (see below) |
S. pneumoniae H. influenzae Enteric Gram negative rods |
Ceftriaxone or Ertapenem or Levofloxacin |
For severe penicillin allergy: Levofloxacin |
Obtain tracheal aspirate for Gram stain and culture |
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ZSFG/VASF Ventilator-associated pneumonia: intubated > 5 days or with multifocal disease, large or loculated pleural effusion, or cavitary disease |
Enteric Gram-negative rods Pseudomonas Acinetobacter Staph aureus |
Vancomycin PLUS ONE OF: Cefepime or Piperacilin/ tazobactam |
For severe PCN allergy: PLUS |
Obtain tracheal aspirate for Gram stain and culture |