Spectrum: Local Antimicrobial Stewardship, for Bakersfield Memorial Hospital

CAP - Severe Inpatient

Empiric Therapy

Ceftriaxone 1 gm IV every 24 hr

PLUS

Azithromycin 500 mg IV every 24 hr

When to Cover for MRSA and Pseudomonas

  • Prior isolation of MRSA or Pseudomonas

  • Hospitalization in the last 90 days with exposure to parenteral antibiotics

Vancomycin

PLUS

Cefepime 2 gm IV every 8 hr

OR

Zosyn 3.375 gm IV every 8 hr (4 hr infusion)

Cephalosporin Allergy

Levofloxacin 750 mg IV/PO every 24 hr*

*Per BMH policy in the absence of severe PCN allergy, levofloxacin will automatically be interchanged to ceftriaxone plus azithromycin.

Macrolide Allergy

Ceftriaxone 1 gm IV every 24 hr

PLUS

Doxycycline 100 mg IV/PO every 12 hr

Duration

5-7 days

Patients with negative sputum cultures on admission and responding to therapy at 72 hr can have anti-MRSA and anti-pseudomonal therapy discontinued.