Patients who recover within 24-48 hours likely had aspiration pneumonitis and should have their antibiotics stopped
7 days for true aspiration pneumonia
May require prolonged therapy (3-4 weeks or until resolved) if lung abscess develops
OR, IF Immunocompromised or known ESBL/AmpC
IF AT RISK FOR MRSA ADD
Stop vancomycin if MRSA absent from culture/screening swabs
If no pseudomonas isolated, can narrow coverage or use non-anti-pseudomonal doses
Cultures are helpful in guiding therapy, especially if organisms are present on the gram stain
Refrain from treating candida in the sputum unless suspecting systemic candidiasis (e.g. neutropenic, transplant patients)
Cultures may continue to be positive despite treatment in ventilated patients; refrain from re-culturing if patient improving
Usual pathogens
Early Aspiration (< 5 days of hospitalization)