General framework for empirical initial antimicrobial treatment of VAP
| Class of antimicrobial agents | Agents and dosages | |
|---|---|---|
| *Consider also limezolid and synercid. | ||
| Ventilated patients: | ||
| Early onset, no risk factors | Cephalosporin II | • Cefuroxime 3 × 1.5 g |
| or | ||
| Cephalosporin III | • Cefotaxime 3 × 2 g or | |
| • Ceftriaxone 2 × 1 g | ||
| or | ||
| Aminopenicillin/β-lacatamase inhibitor | • Amoxicillin/clavulanic acid 3 × 2.2 g | |
| or | ||
| Third or fourth G quinolone | • Levofloxacin 2 × 500 mg | |
| or | • Moxifloxacin 1 × 400 mg | |
| Clindamycin/aztreonam | • Clindamycin 3 × 600 mg | |
| • Aztreonam 3 × 2 g | ||
| Late onset, no risk factors | Quinolone | • Ciprofloxacin 3 × 400 mg |
| or | ||
| Aminoglycoside | • Gentamicin 5–7 mg/kg | |
| • Tobramycin 5–7 mg/kg | ||
| • Amikacin 1 × 15 mg/kg | ||
| plus | ||
| Antipseudomonal β-lactam/β-lactamase inhibitor | • Piperacillin/tazobactam 3 × 4.5 g | |
| or | ||
| Ceftazidime | • Ceftazidime 3 × 2 g | |
| or | ||
| Carbapenems | • Imipenem/cilastatin 3 × 1 g | |
| • Meropenem 3 × 1 g | ||
| plus/minus | ||
| Vancomycin* | • Vancomycin 2 × 1 g | |
| Early or late onset, risk factors | Risk factors for P aeruginosa: see late onset | |
| Risk factors for MRSA: + vancomycin* | • Vancomycin 2 × 1 g | |
| Risk factor for legionellosis: macrolide | • Erythromycin 4 × 1 g | |
| or | ||
| • Azithromycin 1 × 500 mg | ||
| or | ||
| • Clarithromycin 2 × 500 mg | ||
| or | ||
| • Levofloxacin 2 × 500 mg | ||
| or | ||
| • Moxifloxacin 1 × 400 mg | ||
| Non-ventilated patients: | ||
| Early onset, no risk factors | See ventilated patient | |
| Late onset, no risk factors | See ventilated patient; possibly monotherapy in the absence of severe pneumonia | |
| Early or late onset, risk factors | See ventilated patient, early or late onset, risk factors | |