Healthcare-acquired or Ventilator-associated Pneumonia

Patient Population: Pediatric
Condition Major Pathogens  First-choice Therapy Alternative Therapy Comments
Healthcare-acquired or ventilator-associated pneumonia 

Pseudomonas aeruginosa, other resistant gram- negative bacteria 

Staphylococcus aureus 

50 mg/kg/dose (max 2000 mg/dose) IV q8h  

For patients with ventilator-associated pneumonia or patients with less severe disease if patient has a history of  documented MRSA infection or carriage within the last 6 months:

ADD Vancomycin  

(follow link for dosing & monitoring)   

Penicillin or cephalosporin allergy with higher risk for allergic reaction

Consult ID/ASP 

Consider ID consultation especially for patients with prior antimicrobial exposure or antibiotic-resistant infection 

Lower respiratory culture recommended if able to obtain, tailor therapy to identified organism 

Modify therapy by stopping vancomycin if MRSA is not isolated or if the patient has a negative screening MRSA nasal PCR (collected within preceding 1 week)  

Further modify therapy to target identified organism(s) from respiratory cultures. Avoid continuing anti-pseudomonal therapy if Pseudomonas not isolated  

Duration: 7 days 

Pediatric Empiric Antimicrobial Therapy Guidelines

This is a subsection of the UCSF Benioff Children’s Hospitals Empiric Antimicrobial Therapy Guidelines, developed by the Pediatric Antimicrobial Stewardship Programs at each campus to inform initial selection of empiric antimicrobial therapy for children at the UCSF Benioff Children’s Hospitals and affiliated outpatient sites. 

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. Durations provided are usual recommendations for patients who are responding appropriately to therapy. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP) at the campus where your patient is receiving care.  

For questions or feedback about these guidelines, please email primary content owners, Rachel Wattier, Pediatric ASP Medical Director at BCH SF and Prachi Singh, Pediatric ASP Medical Director at BCH OAK. 

The content of these guidelines was updated in July 2021. See Summary and Rationale for Changes (password login to Box needed) for detailed explanations of the content changes.