Treatment MUST be narrowed based on culture results. See “Narrowing Therapy” below.
Vancomycin (Dosing per pharmacy)
AND ONE OF
Pip/Tazo 3.375g IV q8h, infused over 4 hours
Cefepime 1-2g IV q8h*
*2g IV q8h if neutropenic
Meropenem 1g IV q8h
Aztreonam 2g IV q8h*
*Severe penicillin allergy
IF HIGH CONCERN FOR MULTIDRUG RESISTANT ORGANISM, ADD EITHER
Gentamicin 7mg/kg IV q24h*
*Preferred as the second anti-pseudomonal agent due to the high rates of resistance to fluroquinolones in the institution. 32% of Pseudomonas at UCLA was cipro-resistant in 2016
Ciprofloxacin 400mg IV q8h
7-8 days if the patient has clinical improvement, Pseudomonas may require longer treatment (14 days).
If symptoms persist at 8 days consider: alternate sources for infection, non-infectious causes (e.g. ARDS, CHF), and bronchoscopy with cultures.
VAP associated with S. aureus bacteremia should be treated for a minimum of 14 days.
If the patient is on antibiotic therapy or has recently been on antibiotic therapy, choose an agent from a different class.
Nebulized antibiotics (aminoglycosides or colistin) are not recommended for routine use due to an absence of data on their utility except in specific patient populations (e.g., cystic fibrosis). Neublized antibiotics should not be used for suppressive therapy in patients with tracheal colonization.