Pediatric Guidelines: Respiratory Infections - Healthcare-Associated Pneumonia

Condition Major Pathogens First Choice Therapy Alternative Therapy Comments
Healthcare-associated or ventilator-associated pneumonia

Pseudomonas aeruginosa, other resistant Gram negatives

Staphylococcus aureus

Piperacillin-tazobactam (Zosyn) 100mg/kg/dose piperacillin q6h (max 4g piperacillin/dose)

ADD Vancomycin for patients with severe disease or patients with non-severe disease who have history of MRSA infection or colonization:

Age 3mo-<12yo: 17.5mg/kg/dose IV q6h (initial max 1g/dose)

Age >=12 yo: 15mg/kg/dose IV q6h (initial max 1g/dose)  

Non-severe penicillin allergy:

Replace Piperacillin-tazobactam with Cefepime 50mg/kg/dose IV q8h (max 2g/dose)

Consider ID consultation especially for patients with prior antimicrobial exposure or drug-resistant infections

Mini-BAL recommended if able to obtain, tailor therapy to identified organism

Severe penicillin allergy:

Consult ID/ASP

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. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).