What are the recommended antibiotics for Hospital-Acquired (HA) pneumonia?

From the Guidelines

Hospital-Acquired (HA) pneumonia should be treated with piperacillin-tazobactam, cefepime, levofloxacin, or a carbapenem for patients with low risk of mortality and no risk factors for methicillin-resistant Staphylococcus aureus (MRSA) 1.

Recommended Antibiotics for HA Pneumonia

• For patients with low risk of mortality and no risk factors for MRSA:
  • Piperacillin-tazobactam 4.5 g IV q6h
  • Cefepime 2 g IV q8h
  • Levofloxacin 750 mg IV daily
  • Imipenem 500 mg IV q6h
  • Meropenem 1 g IV q8h
• For patients with low risk of mortality but with risk factors for MRSA:
  • Add vancomycin or linezolid to the above regimens
• For patients with high risk of mortality or who received intravenous antibiotics in the previous 90 days:
  • Empiric double coverage using antibiotics from two different classes with activity against Pseudomonas aeruginosa, such as:
    • Piperacillin-tazobactam 4.5 g IV q6h
    • Cefepime or ceftazidime 2 g IV q8h
    • Levofloxacin 750 mg IV daily
    • Ciprofloxacin 400 mg IV q8h
    • Imipenem 500 mg IV q6h
    • Meropenem 1 g IV q8h
    • Aztreonam 2 g IV q8h
  • Plus vancomycin or linezolid for MRSA coverage It is essential to note that the choice of antibiotic should be based on the local antibiogram and the patient's specific risk factors for MRSA and other multidrug-resistant pathogens 1.

From the Research

Recommended Antibiotics for Hospital-Acquired Pneumonia

The choice of empirical antibiotic therapy for hospital-acquired pneumonia (HAP) is crucial for improving outcomes. According to various studies, the following antibiotics are recommended:

• Beta-lactams, such as imipenem or ticarcillin-clavulanate, which are effective against a wide range of organisms, including Pseudomonas species, Enterobacter species, and Staphylococcus aureus 2
• Combinations including a beta-lactam, which are recommended in patients with risk factors for drug-resistant microorganisms and septic shock 3
• Aminoglycosides, such as amikacin, which are effective against more than 80% of the seven most common isolates, but should be used with caution due to the risk of renal toxicity 2
• Fluoroquinolones, such as ciprofloxacin, which are effective against a wide range of organisms, but should be used with caution due to the risk of collagen degradation and cardiovascular events 3
• Linezolid or vancomycin, which are viable options for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) 3, 4

Considerations for Antibiotic Selection

When selecting antibiotics for HAP, the following factors should be considered:

• Local microbiology data and resistance patterns 3, 5
• Patient risk factors, such as comorbidities and previous antibiotic use 3, 5
• The need for broad-spectrum coverage, while minimizing the risk of antibiotic resistance 6, 3
• The potential for de-escalation therapy, which involves switching to a narrower-spectrum antibiotic once the pathogen is identified 4, 5

Duration of Antibiotic Therapy

The duration of antibiotic therapy for HAP is typically 8 days, but may vary depending on the specific pathogen and patient response 4. A de-escalating strategy, which involves switching to a narrower-spectrum antibiotic once the pathogen is identified, can help reduce the risk of antibiotic resistance and improve patient outcomes 4, 5.