What is the recommended treatment for hospital-acquired pneumonia?

From the Guidelines

The recommended treatment for hospital-acquired pneumonia (HAP) should include empiric broad-spectrum antibiotics, such as piperacillin-tazobactam 4.5 g IV q6h, cefepime 2 g IV q8h, or levofloxacin 750 mg IV daily, with consideration of MRSA coverage using vancomycin 15 mg/kg IV q8-12h or linezolid 600 mg IV q12h, as outlined in the 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society 1.

When determining the appropriate treatment for HAP, it is essential to consider the patient's risk of mortality and factors that increase the likelihood of methicillin-resistant Staphylococcus aureus (MRSA) 1.

• For patients not at high risk of mortality and without factors increasing the likelihood of MRSA, treatment options include piperacillin-tazobactam 4.5 g IV q6h, cefepime 2 g IV q8h, levofloxacin 750 mg IV daily, imipenem 500 mg IV q6h, or meropenem 1 g IV q8h 1.
• For patients not at high risk of mortality but with factors increasing the likelihood of MRSA, treatment options include 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, or aztreonam 2 g IV q8h 1.
• For patients at high risk of mortality or those who have received intravenous antibiotics during the prior 90 days, treatment should include two of the following antibiotics, avoiding two β-lactams: 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, amikacin 15-20 mg/kg IV daily, gentamicin 5-7 mg/kg IV daily, tobramycin 5-7 mg/kg IV daily, or aztreonam 2 g IV q8h, plus vancomycin 15 mg/kg IV q8-12h or linezolid 600 mg IV q12h for MRSA coverage 1.

It is crucial to note that treatment duration and de-escalation should be based on culture results, clinical response, and local antibiogram data, with a typical treatment duration of 7-8 days for most patients 1.

From the FDA Drug Label

Levofloxacin tablets are indicated in adult patients for the treatment of nosocomial pneumonia due to methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, or Streptococcus pneumoniae.

Nosocomial Pneumonia Adult patients with clinically and radiologically documented nosocomial pneumonia were enrolled in a randomized, multi-center, double-blind trial. Patients were treated for 7 to 21 days. One group received ZYVOX I. V. Injection 600 mg q12h, and the other group received vancomycin 1 g q12h IV.

The recommended treatment for hospital-acquired pneumonia includes:

• Levofloxacin for nosocomial pneumonia due to methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, or Streptococcus pneumoniae 2
• Linezolid for nosocomial pneumonia, with cure rates of 57% in clinically evaluable patients and 46% in vancomycin-treated patients 3 Key points:
• Levofloxacin and linezolid are both indicated for the treatment of hospital-acquired pneumonia
• The choice of treatment depends on the causative pathogen and the patient's clinical condition
• Combination therapy with an anti-pseudomonal β-lactam is recommended when Pseudomonas aeruginosa is a documented or presumptive pathogen 2

From the Research

Hospital-Acquired Pneumonia Treatment

The recommended treatment for hospital-acquired pneumonia (HAP) involves the timely administration of appropriate antibiotic therapy, which has been shown to improve outcomes 4.

• Antibiotic Treatment Algorithms: Studies have compared local ecology-based algorithms (LEBA) to surveillance culture-based algorithms (SCBA) in terms of appropriate coverage and spectrum of antimicrobial activity, with SCBA proposing more narrow-spectrum therapy and reducing the use of broad-spectrum drugs 4.
• Prevention Strategies: Oral care, aspiration precautions, and oral and digestive decontamination with antibiotics may be effective in preventing HAP, although most potential prevention strategies remain unproven 5.
• Comparison to Ventilator-Associated Pneumonia (VAP): HAP is distinct from VAP, with differences in natural history, risk factors, and bacteriology, necessitating a different approach to therapy 6.
• Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA) Pneumonia: Linezolid may be more effective than vancomycin for the treatment of MRSA nosocomial pneumonia, with higher clinical success rates and lower nephrotoxicity 7, 8.
• Therapeutic Approach: The best therapeutic approach for MRSA pneumonia is still unclear, with limited information available on the treatment of community-acquired pneumonia and the effectiveness of newer antibiotics 8.