Hospitalized Adults: Respiratory Tract Infections: Hospital-Acquired Pneumonia

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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

Hospital-acquired pneumonia 

EARLY ONSET

including ventilator-associated or less than 5 days of hospitalization, no risk factors for drug-resistant organisms*

 

S. aureus

S.pneumoniae

H.influenzae

 

Antibiotic sensitive enteric gram negative bacilli:

E. coli

Enterobacter aerogenes

Klebsiella pneumoniae

Proteus mirabilis

Serratia marcesans

Vancomycin

PLUS one of

Levofloxacin 750 mg IV daily

OR

Ertapenem 1 g IV daily 

 

 

Mini-BAL recommended at UCSF.

 

*Risk factors include recent antibiotic exposure (within 30 days).

 

Consider influenza testing and treatment with oseltamivir when influenza is known to be circulating.

Hospital-acquired pneumonia

LATE ONSET

including ventilator-associated OR ≥ 5 days of hospitalization or risk factors for resistant organisms*

E. coli

Enterobacter aerogenes

P. aeruginosa

Klebsiella pneumoniae

S. aureus 

Vancomycin

PLUS one of:

Piperacillin/tazobactamID-R: SFGH 4.5 g IV q6h  

OR

CefepimeID-R: SFGH VASF 2 g IV q8-12h

 

Alternatively:

Vancomycin

PLUS

MeropenemID-R: SFGH VASF 1-2 g IV q8h** 

For severe PCN allergy3:

Vancomycin2

PLUS

AztreonamID-R: SFGH 2 g IV q8h

WITH OR WITHOUT***:

Tobramycin

 

Mini-BAL recommended at UCSF. 

 

*Risk factors include recent antibiotic exposure (within 30 days). 

 

**Consider use in patients with current or recent use (< 7 days) of piperacillin/tazobactam or cefepime and in patients with recent infection with multidrug resistant gram-negative bacteria. 

 

 ***Weigh risks and benefits of adding aminoglycoside for critical illness, immunocompromise, or history of infection or colonization with drug-resistant Gram-negative rods.