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)
- 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