Hospital-Acquired

Consult

Consider Respirology/Thoracic Surgery and Infectious Diseases consultation

Pleural Drainage

Chest tube drainage

Antibiotics

Piperacillin-tazobactam 4.5 g IV q6h

AND

Vancomycin

Can usually be discontinued if blood and other relevant cultures are negative for MRSA

Severe Penicillin Allergy

Ciprofloxacin 750 mg PO BID

AND

Metronidazole 500 mg PO BID

AND

Vancomycin

Can usually be discontinued if blood and other relevant cultures are negative for MRSA

If High Risk for ESBL

Meropenem 500 mg IV q6h

Duration

3-6 weeks

Oral Step-Down

Antibiotics with good oral availability should be administered orally unless contraindicated: metronidazole, moxifloxacin, ciprofloxacin, and clindamycin

Amoxicillin-clavulanate can be used once adequate source control and clinical improvement