Late onset
> 4 days hospitalization, non-ICU, no mechanical ventilation, no broad-spectrum antibiotics, no other risk factors
(For associated risk factors/high endemic MRSA, see below)
Usual Pathogens
Enterobacterales
| Therapy | Dose | Duration |
|---|---|---|
| [Ceftriaxone | 1-2g IV daily | 7 days |
| or | ||
| Levofloxacin IV/PO] | 750mg IV/PO daily | 7 days |
| +/- | ||
| Gentamicin | 7mg/kg IV daily | Reassess once C&S results available |
Aspiration
See Aspiration pneumonia, Hospital acquired.
Coma, diabetes, head injury, recent influenza, IDU
Usual PathogensEnterobacterales
S. aureus/MRSA
| Therapy | Dose | Duration |
|---|---|---|
| [Ceftriaxone | 1-2g IV daily | 7 days |
| or | ||
| Levofloxacin | 750mg IV/PO daily | 7 days |
| +/- | ||
| Gentamicin] | 7mg/kg IV daily | Reassess once C&S results available |
| + | ||
| [Vancomycin | 25-30mg/kg IV once then | 7 days |
| 15mg/kg IV q8-12h | ||
| or | ||
| Linezolid] | 600mg IV/PO q12h | 7 days |
Prior (≤ 3 months) broad spectrum antibiotics, structural lung disease (bronchiectasis/cystic fibrosis), immunosuppression
If possible, use agents from a different antibiotic class than previously used.
Mechanical ventilation (see VAP)
Usual PathogensEnterobacterales
P. aeruginosa
Acinetobacter spp
S. aureus/MRSA
| Therapy | Dose | Duration |
|---|---|---|
| [Piperacillin-tazobactam | 4.5g IV q6h | 7-14 days |
| or | ||
| Imipenem | 500mg IV q6h | |
| or | ||
| Meropenem] | 500mg IV q6h | |
| + | ||
| Tobramycin | 7mg/kg IV q24h | 5 days |
If MRSA suspected, add:
| Therapy | Dose | Duration |
|---|---|---|
| Vancomycin | 25-30mg/kg IV once then | Minimum 14 days for confirmed MRSA |
| 15mg/kg IV q8-12h | ||
| or | ||
| Linezolid | 600mg IV/PO q12h | Minimum 14 days for confirmed MRSA |
Severe ß-lactam allergy
| Therapy | Dose | Duration |
|---|---|---|
| [Vancomycin | 25-30mg/kg IV once then | Minimum 14 days for confirmed MRSA |
| 15mg/kg IV q8-12h | ||
| or | ||
| Linezolid] | 600mg IV/PO q12h | Minimum 14 days for confirmed MRSA |
| + | ||
| Ciprofloxacin IV/PO | 400mg IV q8-12h/750mg PO bid | 7-14 days |
| + | ||
| Tobramycin | 7mg/kg IV q24h | Reassess once C&S results available |