Pneumonia, Hospital-acquired or Ventilator-associated

Pseudomonas aeruginosa, other resistant gram- negative bacteria 

Staphylococcus aureus 

Cefepime  
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