6
Treatment
Optimization
Î For patients with HAP/VAP, ATS and IDSA suggest that antibiotic dosing
be determined using Pharmacokinetic/Pharmacodynamic (PK/PD) data,
rather than the manufacturer's prescribing information (W-VL).
Inhaled Antibiotic
Î For patients with VAP due to Gram-negative bacilli that are susceptible
to only aminoglycosides or polymyxins (colistin or polymyxin B), ATS
and IDSA suggest both inhaled and systemic antibiotics, rather than
systemic antibiotics alone (W-VL).
Pathogen-Specific Therapy
Î ATS and IDSA recommend that MRSA HAP/VAP be treated with either
vancomycin or linezolid rather than other antibiotics or antibiotic
combinations (S-M).
Î For patients with HAP/VAP due to P. aeruginosa, ATS and IDSA
recommend that the choice of an antibiotic for definitive (not empiric)
therapy be based upon the results of antimicrobial susceptibility
testing (S-L).
Î For patients with HAP/VAP due to P. aeruginosa, ATS and IDSA
recommend against aminoglycoside monotherapy (S-VL).
Î For patients with HAP/VAP due to P. aeruginosa who are not in
septic shock or at a high risk for death, and for whom the results of
antibiotic susceptibility testing are known, ATS and IDSA recommend
monotherapy using an antibiotic to which the isolate is susceptible
rather than combination therapy (S-L).
Î For patients with HAP/VAP due to P. aeruginosa who remain in
septic shock or at a high risk for death when the results of antibiotic
susceptibility testing are known, ATS and IDSA suggest combination
therapy using 2 antibiotics to which the isolate is susceptible rather
than monotherapy (W-VL).
Î For patients with HAP/VAP due to P. aeruginosa, ATS and IDSA
recommend against aminoglycoside monotherapy (S-VL).
Î For patients with HAP/VAP due to extended-spectrum β-lactamase
(ESBL)-producing Gram-negative bacilli, ATS and IDSA recommend
that the choice of an antibiotic for definitive (not empiric) therapy
be based upon the results of antimicrobial susceptibility testing and
patient-specific factors (S-VL).
