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.
