APBL-Susceptible | Spectrum

Microbiology

The regimen below provides coverage for late onset pathogens (>5 days)

Antimicrobial Treatment

Cefepime 2 G IV Q8h

Generally preferred to minimize risk of acute kidney injury with concomitant vancomycin and piperacillin/tazobactam

OR

Piperacillin-tazobactam 4.5 G IV Q6h

WITH OR WITHOUT

Azithromycin 500mg IV/PO x 1

For atypical coverage
Continue if Legionella urinary antigen positive or if clinical suspicion high

OR

Doxycycline 100mg PO Q12h

If Azithromycin cannot be used

IF CRITICALLY ILL, ADD

Vancomycin 25 mg/kg IV OT as loading dose, THEN maintenance dose per PH Guidelines (consider pharmacy consult to dose)

D/C if MRSA nasal swab PCR is negative

Critical Illness

Intensive care unit admission
Need for mechanical ventilation or vasopressors
Other severe complications of pneumonia (e.g. empyema)

Potential PO Transition

Consider transition to oral therapy once clinically improved/stable

Depending on causative pathogen, oral options may be even narrower-spectrum than those presented herein
Narrowest effective therapy is generally preferred to minimize adverse effects and emergence of resistance

Levofloxacin 750mg PO Q24h

Total Duration

7 Days

Duration of therapy may be extended (e.g. total 10-14 days) for patients who fail to respond clinically and/or are definitely diagnosed with pneumonia due to non-lactose fermenting gram-negative bacteria (e.g. P. aeruginosa) or Legionella spp.