Diagnosis | Common Pathogens | Drug(s) of First Choice | Alternative Drug(s) | Comments | Expected Duration |
---|---|---|---|---|---|
Pneumonia in patient admitted from skilled nursing or other long term care facility after at least one week stay, admitted to the floor |
S. pneumoniae S. aureus H. influenzae Enteric Gram negative bacilli P. aeruginosa |
PLUS one of OR OR Piperacillin/tazobactam |
For severe beta-lactam allergy PLUS Levofloxacin |
Obtain sputum for Gram stain and culture Stop vancomycin at 48 hours if admission MRSA PCR is negative and/or no MRSA isolated from clinical cultures |
5 days |
Pneumonia with significant prior healthcare exposure, admitted to ICU |
S. pneumoniae S. aureus H. influenzae Enteric Gram negative bacilli P. aeruginosa Legionella |
PLUS one of OR OR PLUS Azithromycin |
For severe beta-lactam allergy: PLUS PLUS |
Obtain sputum or tracheal aspirate for Gram stain and culture Patients coming from long-term acute care facilities are at high risk for resistant organisms; consider additional gram-negative coverage |
5 days |
ZSFG and SFVA Hospital-acquired pneumonia EARLY ONSET including ventilator-associated OR– < 5 days of hospitalization, no risk factors for drug-resistant organisms* |
Staph. aureus S.pneumoniae H.influenzae
Antibiotic sensitive enteric gram negative bacilli: E. coli Enterobacter aerogenes Klebsiella pneumoniae Proteus mirabilis Serratia marcesans |
PLUS one of EITHER: Levofloxacin 750mg IV daily OR |
*Risk factors include recent antibiotic exposure (within 30 days)
Consider influenza testing and treatment with oseltamivir when influenza is known to be circulating |
7 days | |
ZSFG and SFVA 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 |
PLUS one of EITHER: OR
Alternatively: PLUS |
For severe PCN allergy: PLUS WITH OR WITHOUT***: |
*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 |
7 days |
UCSFMC Hospital-acquired and Ventilator-associated pneumonia | UCSF Guidelines for Hospital-acquired/Ventilator-associed Pneumonia | 7 days |
Clinical Infectious Diseases, Volume 63, Issue 5, 1 September 2016, Pages e61–e111, https://doi.org/10.1093/cid/ciw353