Table 3.
Initial combination empiric therapy for hospital-acquired pneumonia in high-risk patients (options for treating each pathogen)
| MDR/Pseudomonas #1a | Cephalosporin (cefepime or ceftazidime) OR | Carbapenem (imipenem or meropenem) OR | β-Lactam (piperacillin-tazobactam) |
| MDR/Pseudomonas #2a | Fluoroquinolone (ciprofloxacin or levofloxacin) OR | Aminoglycoside (amikacin, gentamicin, or tobramycin) | |
| MRSA | Linezolid OR | Vancomycin | |
| Legionella | Fluoroquinolone (ciprofloxacin or levofloxacin) OR | Azithromycin |
If a pathogen is suspected, each should be treated with one antimicrobial from each row.
a
Given the increasing resistance patterns, multidrug-resistant (MDR) organisms/Pseudomonas should be covered with combination therapy and 2 antimicrobials (one from each row), in addition to coverage for MRSA and Legionella, if applicable.
Data from American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388–416.