What are the recommended antibiotics for treating Hospital-Acquired Pneumonia (HAP) at home?

Recommended Antibiotics for Hospital-Acquired Pneumonia (HAP) Treatment at Home

For patients with Hospital-Acquired Pneumonia who can be treated at home, the recommended empiric antibiotic therapy should be based on risk factors for mortality and likelihood of MRSA infection. 1

Antibiotic Selection Algorithm

For patients NOT at high risk of mortality and NO factors increasing likelihood of MRSA:

• One of the following oral options:
  • Levofloxacin 750 mg daily 1, 2
  • Alternatively, if available in oral form:
    • Piperacillin-tazobactam
    • Cefepime
    • Imipenem
    • Meropenem 1

For patients NOT at high risk of mortality but WITH factors increasing likelihood of MRSA:

• One of the following:
  • Levofloxacin 750 mg daily PLUS coverage for MRSA 1
  • Alternatively, if available in oral form:
    • Piperacillin-tazobactam
    • Cefepime or ceftazidime
    • Imipenem
    • Meropenem 1

For patients at HIGH risk of mortality or recent IV antibiotics (within 90 days):

• Two of the following (avoid using two β-lactams together):
  • Levofloxacin 750 mg daily 1
  • Plus MRSA coverage if indicated 1

Risk Factors to Consider

Risk factors for mortality include:

• Need for ventilatory support due to pneumonia
• Septic shock 1

Factors increasing likelihood of MRSA:

• Intravenous antibiotic treatment during the prior 90 days
• Treatment in a unit where MRSA prevalence among S. aureus isolates is >20% or unknown
• Prior detection of MRSA by culture or screening 1

Duration of Therapy

• Hospital-acquired pneumonia generally requires no more than 8 days of therapy in responding patients 3
• Response should be monitored using simple clinical criteria including temperature, respiratory and hemodynamic parameters 1, 3
• C-reactive protein should be measured on days 1 and 3-4, especially in patients with unfavorable clinical parameters 1, 3

Special Considerations

Benefits of oral levofloxacin:

• Levofloxacin has excellent bioavailability when given orally, making it suitable for home treatment 4, 5
• High-dose (750 mg), short-course (5 days) levofloxacin maximizes concentration-dependent antibacterial activity and decreases potential for drug resistance 4, 6
• Studies have shown that full-course oral levofloxacin is as efficacious as standard intravenous-to-oral sequential antibiotic therapy for hospitalized patients with pneumonia 5

Important caveats:

• If Pseudomonas aeruginosa is suspected, combination therapy is recommended rather than monotherapy to prevent resistance 2, 7
• Local antibiogram data should guide therapy whenever possible 1, 3
• For patients with structural lung disease increasing risk of gram-negative infection (bronchiectasis or cystic fibrosis), two antipseudomonal agents are recommended 1
• Monitor for fluoroquinolone adverse events including tendinopathy, peripheral neuropathy, and CNS effects 3