Spectrum: Local Antimicrobial Stewardship, for Markham Stouffville Hospital

At Risk for Pseudomonas

Empiric Antimicrobial Therapy

Piperacillin-tazobactam 4.5g IV q6h

CONSIDER ADDING

Azithromycin 500mg IV q24h

If at risk for Legionella

Legionella Risk Factors

  • Older age

  • Immunocompromised

  • Diabetes

  • Chronic lung disease

  • Heavy smoker

  • Known exposure

  • Season: June to October

  • Positive urine Legionella antigen test

Severe Beta-Lactam Allergy

Gentamicin 5-7mg/kg IV q24h

PLUS EITHER

Meropenem 500mg IV q6h

OR

Moxifloxacin 400mg IV daily

ALSO CONSIDER ADDING

Azithromycin 500mg IV q24h

  • If at risk for Legionella

  • Not required if on Moxifloxacin

Legionella Risk Factors

  • Older age

  • Immunocompromised

  • Diabetes

  • Chronic lung disease

  • Heavy smoker

  • Known exposure

  • Season: June to October

  • Positive urine Legionella antigen test