Empiric Therapy Regimens
Empiric therapeutic regimens for hospital-acquired pneumonia (HAP) and ventilator-associated event (formerly known as ventilator-associated pneumonia [VAP]) are outlined below, including those for early onset, late onset, and multidrug-resistant (MDR) factors. [1, 2, 3, 4]
Definitions
Definitions of HAP and VAE are as follows:
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HAP: Diagnosis made more than 48 hours after admission and did not appear to be incubating at the time of admission
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VAE: Diagnosis made 48-72 hours after endotracheal intubation
Hospital-acquired pneumonia or ventilator-associated event
Regimens for early onset (< 5 days since admission) and no MDR risk factors are as follows:
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Ceftriaxone 2 g IV or IM every 24 hours or
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Levofloxacin 750 mg IV or PO every 24 hours or
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Ampicillin-sulbactam 3 g IV or IM every 6 hours or
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Ertapenem 1 g IV or IM every 24 hours or
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Aztreonam 2 g IV every 8 hours
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Duration of therapy: 8 days
Regimens for late onset (≥5 days since admission), MDR risk factors present, or diagnosis of HCAP are as follows:
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Cefepime 2 g IV every 8 hours or
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Ceftazidime 2 g IV every 8 hours or
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Meropenem 1 g IV every 8 hours or
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Cefiderocol 2 g IV q8h or
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Imipenem-cilastatin 500 mg IV every 6 hours or 1 g IV every 8 hours or
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Imipenem-cilastatin-relebactam 1.25 g IV every 6 hours [5] or
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Ceftazidime-avibactam 2.5 g IV every 8 hours or
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Ceftolozane-tazobactam 3 g IV every 8 hours [6] or
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Piperacillin-tazobactam 4.5 g IV every 6 hours
PLUS
PLUS
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Ciprofloxacin 400 mg IV every 8 hours or
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Levofloxacin 750 mg IV every 24 hours
Duration of therapy:
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If clinical improvement is noted in 48-72 hours and cultures are negative, consider stopping antibiotics
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If clinical improvement is noted in 48-72 hours and cultures are positive, adjust regimen per susceptibilities and continue antibiotics for 7-8 days
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If there is no clinical improvement and cultures are negative, look for alternative diagnoses
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If there is no clinical improvement and cultures are positive, adjust regimen per susceptibilities
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