Clinical Pearls

Clinical Pearls

Recent studies have shown that, compared with standard treatment durations of 10 days or more, 7-day treatment durations were associated with fewer relapses caused by multiresistant pathogens WITHOUT affecting mortality rate

To avoid prolonged use of broad-spectrum antibiotics, it is essential to de-escalate therapy according to the results of microbiologic analyses

  • The role of antimicrobials in the treatment of ventilator-associated tracheobronchitis is controversial.

  • Consider initiating antimicrobial therapy if clinical deterioration (e.g. progressive hypoxemia)

Ventilator-associated tracheobronchitis

  • Fever with no other identifiable cause, with:
    • Significant purulent secretions
    • Positive endotracheal aspirate culture
    • ABSENCE of pneumonia on a chest X-ray

  • Empiric double coverage of Pseudomonas aeruginosa is to maximize the likelihood of having at least one active agent (due to increased risk of resistance with Pseudomonas).

  • If Pseudomonas is isolated, step-down to monotherapy (according to susceptibility data)

  • Use of aminoglycosides (e.g. tobramycin and gentamicin) as monotherapy for the treatment of pneumonia is NOT recommended (even if susceptibility is confirmed)

  • DO NOT use Daptomycin to treat pneumonia; Daptomycin is inactivated by pulmonary surfactant.

  • If MRSA infection, use vancomycin (or linezolid if vancomycin is ineffective or inappropriate)

Serial procalcitonin levels (if available), in combination with clinical evaluation, may assist in the decision to discontinue antibiotics