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Pathogens
Antimicrobials
The regimen below provides coverage for late onset pathogens (>5 days)
Late Onset Pathogens
Cefepime 2G 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
PLUS
Vancomycin 15 mg/kg IV Q8-12h
Consider pharmacy consult to dose and discontinue if MRSA nasal swab PCR is negative
WITH OR WITHOUT
Azithromycin 500mg IV/PO x 1
For atypical coverage
Continue if Legionella urinary antigen positive or if clinical suspicion high
Doxycycline 100mg PO Q12h
If Azithromycin cannot be used
Levofloxacin 750mg PO Q24h
For documented Legionella pneumonia
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.
