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8 Treatment Table 2. Recommended Initial Empiric Antibiotic Therapy for HAP Non-Ventilator-Associated Pneumonia Not at High Risk of Mortality a and no Factors Increasing the Likelihood of MRSA b,c Not at High Risk of Mortality a but With Factors Increasing the Likelihood of MRSA b,c One of the following: One of the following: Piperacillin-tazobactam d 4.5 g IV q6h d OR Piperacillin-tazobactam d 4.5 g IV q6h OR Levofloxacin 750 daily OR Cefepime d or ceazidime d 2 g IV q8h OR Cefepime d 2 g IV q8h OR • Levofloxacin 750 mg daily OR • Ciprofloxacin 400 mg IV q8h • Imipenem d, e 500 mg IV q6h d OR • Meropenem d 1 g IV q8h • Imipenem d, e 500 mg IV q6h OR • Meropenem d 1 g IV q8h Aztreonam 2 g IV q8h Plus: • Vancomycin 15 mg/kg IV q8–12h with goal to target 15–20 mg/mL trough level (consider a loading dose of 25–30 mg/kg × 1 for severe illness) OR • Linezolid 600 mg IV q12h If patient has severe penicillin allerg y and aztreonam is going to be used instead of any β-lactam–based antibiotic, include coverage for MSSA. a Risk factors for mortality include need for ventilatory support due to pneumonia and septic shock. b Indications for MRSA coverage include IV antibiotic treatment during the prior 90 days, and treatment in a unit where the prevalence of MRSA among S. aureus isolates is not known or is >20%. Prior detection of MRSA by culture or non-culture screening may also increase the risk of MRSA. e 20% threshold was chosen to balance the need for effective initial antibiotic therapy against the risks of excessive antibiotic use; hence, individual units can elect to adjust the threshold in accordance with local values and preferences. If MRSA coverage is omitted, the antibiotic regimen should include coverage for MSSA.