Hospital-Acquired, Health Care-Associated, and Ventilator-Associated Pneumonia Empiric Therapy 

Updated: Oct 26, 2015
  • Author: Darvin Scott Smith, MD, MSc, DTM&H; Chief Editor: Thomas E Herchline, MD  more...
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Empiric Therapy Regimens

Empiric therapeutic regimens for hospital-acquired pneumonia (HAP), health care–associated pneumonia (HCAP), and ventilator-associated pneumonia (VAP) are outlined below, including those for early onset, late onset, and multidrug-resistant (MDR) factors. [1, 2, 3, 4]

Definitions

See the list below:

  • HAP: diagnosis made > 48h after admission
  • VAP: diagnosis made 48-72h after endotracheal intubation
  • HCAP: diagnosis made < 48h after admission with any of the following risk factors: (1) hospitalized in an acute care hospital for > 48h within 90d of the diagnosis; (2) resided in a nursing home or long-term care facility; (3) received recent IV antibiotic therapy, chemotherapy, or wound care within the 30d preceding the current diagnosis; and (4) attended a hospital or hemodialysis clinic

Hospital-acquired pneumonia or ventilator-associated pneumonia

Early onset (< 5d since admission) and no MDR risk factors:

Late onset (≥ 5d since admission), MDR risk factors present, or diagnosis of HCAP:

Duration of therapy:

  • If clinical improvement is noted in 48-72h and cultures are negative, consider stopping antibiotics
  • If clinical improvement is noted in 48-72h and cultures are positive, adjust regimen per susceptibilities and continue antibiotics for 7-8d
  • If there is no clinical improvement and cultures are negative, look for alternative diagnoses
  • If there is no clinical improvement and cultures are positive, adjust regimen per susceptibilities