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GuidelinesIDSA/ATS 2019 guideline recommendations1

Empiric treatment options for P. aeruginosa include piperacillin/tazobactam, 4.5 g administered every 6 hours.

ATS, American Thoracic Society; IDSA, Infectious Diseases Society of America.International ERS/ESICM/ESCMID/ALAT 2017 guideline recommendations2

Empiric antibiotic treatment algorithm for hospital-acquired pneumonia/ventilator-associated pneumonia. 
ALAT, Asociación Latinoamericana del Tórax; ERS,International European Respiratory Society; ESCMID, European Society of Clinical Microbiology and Infectious Diseases; ESICM, European Society of Intensive Care Medicine; ICU, intensive care unit; MDR, multidrug-resistant; MRSA, methicillin-resistant Staphylococcus aureus.

#Low risk for mortality is defined as a ≤15% chance of dying, a mortality rate that has been associated with better outcome using monotherapy than combination therapy when treating serious infection.

Empiric antibiotic treatment algorithm for hospital-acquired pneumonia/ventilator-associated pneumonia

For the high-risk population at risk for multidrug-resistant pathogens, initial empiric therapy is determined by:

  • Patients not in septic shock: the recommendation for Gram-negative bacteria is the use of a single agent that is active against P. aeruginosa, such as piperacillin/tazobactam
  • Patients in septic shock: the recommended therapy should be with a dual-pseudomonal regimen that provides coverage for Acinetobacter spp. and ESBL-producing Enterobacteriaceae
  • The Gram-negative regimen should include an antipseudomonal β-lactam such as piperacillin/tazobactam, plus a second agent such as an aminoglycoside or antipseudomonal quinolone
  • For ESBL-producing organisms, the preferred therapy is with a carbapenem. However, depending on local susceptibilities, cefepime and piperacillin/tazobactam may be options
2017 Surgical Infection Society guidelines on management of complicated intra-abdominal infection (CIAI) recommendations3Recommended empiric treatment options for high-risk patients with community-acquired CIAl*

Adapted from Mazuski JE, et al. Surg Infect (Larchmt). 2017.
ReferencesConsider use of aztreonam + metronidazole plus vancomycin as an option for higher-risk patients with a severe reaction to β-lactam agents. Do not add an adjunctive aminoglycoside or fluoroquinolone to a β-lactam agent for empiric treatment of higher-risk patients. Consider use of ceftazidime + metronidazole as an alternative option for empiric therapy of adults and children. This alternative therapy should be reserved primarily for higher-risk patients due to its broader-spectrum antimicrobial activity.Prescribing information for meropenem can be found in the summary of product characteristics available at: https://www.medicines.org.uk/emc/product/9834/smpc/printReferencesReferences:Metlay J, et al. Diagnosis and treatment of adults with community-acquired pneumonia: an official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45–e67.Torres A, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia. Eur Respir J. 2017;50(3):1700582.Mazuski JE, et al. The Surgical Infection Society revised guidelines on the management of intra-abdominal infection. Surg Infect (Larchmt). 2017;18(1):1–76.Resources Learn more Loading Product Information View Product InformationLoading
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