What is the treatment for Hospital-Acquired Pneumonia (HAP)?

From the Guidelines

The treatment for hospital-acquired pneumonia (HAP) typically involves the administration of broad-spectrum antibiotics, such as piperacillin-tazobactam (4.5g IV every 6 hours) or cefepime (2g IV every 8 hours), with duration of therapy ranging from 7-14 days 1.

Key Considerations

• For patients not at high risk of mortality and without factors increasing the likelihood of MRSA, monotherapy with one of the following antibiotics is recommended:
  • Piperacillin-tazobactam
  • Cefepime
  • Levofloxacin
  • Imipenem
  • Meropenem 1
• For patients at high risk of mortality or with factors increasing the likelihood of MRSA, combination therapy with two or more antibiotics is recommended, including coverage for MRSA with vancomycin (15mg/kg IV every 8-12 hours) or linezolid (600mg IV every 12 hours) 1

Antibiotic Selection

• The choice of antibiotic should be based on the patient's risk factors, including the presence of MRSA, and the local antibiogram 1
• For patients with severe penicillin allergy, aztreonam may be used as an alternative to β-lactam-based antibiotics, but should be combined with an agent that provides coverage for MSSA 1

Additional Support

• Respiratory support, such as oxygen therapy and mechanical ventilation, may be necessary to manage respiratory failure and other complications associated with HAP 1

From the FDA Drug Label

1. 2 Nosocomial Pneumonia Piperacillin and Tazobactam for Injection is indicated in adults and pediatric patients (2 months of age and older) for the treatment of nosocomial pneumonia (moderate to severe) caused by beta-lactamase producing isolates of Staphylococcus aureus and by piperacillin and tazobactam-susceptible Acinetobacter baumannii, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa (Nosocomial pneumonia caused by P. aeruginosa should be treated in combination with an aminoglycoside) [see Dosage and Administration (2)]. 2.2 Dosage in Adult Patients with Nosocomial Pneumonia Initial presumptive treatment of adult patients with nosocomial pneumonia should start with piperacillin and tazobactam for injection at a dosage of 4. 5 grams every six hours plus an aminoglycoside, [totaling 18.0 grams (16.0 grams piperacillin and 2. 0 grams tazobactam)], administered by intravenous infusion over 30 minutes.

The treatment for Hospital-Acquired Pneumonia (HAP), also referred to as nosocomial pneumonia, is piperacillin and tazobactam for injection at a dosage of 4.5 grams every six hours plus an aminoglycoside. The recommended duration of treatment is 7 to 14 days 2.

From the Research

Treatment for Hospital-Acquired Pneumonia (HAP)

The treatment for HAP typically involves the use of broad-spectrum antibiotics, with the selection of the most appropriate antimicrobial agent depending on the causative pathogen(s) 3. The following factors should be considered when selecting a treatment:

• Knowledge of underlying local risk factors for antimicrobial resistance
• Disease staging
• Risk factors related to specific pathogens such as Pseudomonas aeruginosa, Acinetobacter spp., and methicillin-resistant Staphylococcus aureus (MRSA)

Antibiotic Treatment Options

Some antibiotic treatment options for HAP include:

• Piperacillin/tazobactam, which was found to be more effective than ceftriaxone plus clindamycin in patients with early non-ventilator HAP 4
• Imipenem, which is often used as part of the initial empiric treatment for HAP, but may not be effective against all causative organisms, particularly those that are resistant to imipenem 5
• Telavancin, which shows potent activity against Gram-positive bacteria, including MRSA, and can be administered once daily 3
• Ceftobiprole medocaril, which exhibits rapid antimicrobial activity against a broad range of both Gram-positive and Gram-negative pathogens, including MRSA 3

Importance of Early and Appropriate Treatment

Early and appropriate treatment of HAP is crucial to optimize therapeutic outcomes, as inappropriate or delayed therapy can greatly increase morbidity and mortality 3. Guidelines consistently emphasize the importance of treating HAP with early and appropriate broad-spectrum antibiotics 3, 6. The use of clinical guidelines in the management of severe HAP has been shown to improve the adequacy of antibiotic treatment and short-term survival, without increasing the emergence of resistant organisms 6.