Lung - Hospital acquired
Varies by setting
- If allergy to penicillin or if known/suspected infection with a multi-drug resistant Gram-negative organism (i.e. ESBL or AmpC producing)
WITH OR WITHOUT
Add as second anti-pseudomonal agent if at risk for multi-drug resistant pathogens or poor outcome
Dosing based on IBW, unless patient's weight is:
- less than IBW, then use actual body weight
- more than 20% above IBW, then using dosing weight
- Add as second anti-pseudomonal agent if at risk for multi-drug resistant pathogens or poor outcome
If Risk Factors for MRSA, then consider ADDING:
Target trough: 10 to 15 mg/L
Consider capping the loading dose at a maximum of 3,000 mg and maintenance doses at a maximum of 2,000 mg.
Dose adjustment required in renal dysfunction.
History of MRSA infection or colonization
Household contact with a MRSA colonized individual
IV drug use
Recent travel to or residing in an MRSA endemic region or community
Dose adjustment require in renal impairment for all above antimicrobials.
Use of IV antibiotics in the last 90 days
Chronic lung disease (e.g. brochiectasis, cystic fibrosis)
In intensive care unit (ICU) when symptoms appear, or transferred from ICU in last 48 hours
Females IBW = 45.5 kg + [0.92 x (height in cm – 150 cm)] OR 45.5 kg + 2.3 × [(height in inches – 60 inches)]
Males IBW = 50 kg + 0.92 x [(height in cm – 150 cm)] OR 50 kg + 2.3 × [(height in inches – 60 inches)]
Dosing weight (kg) = IBW + 0.4 × (actual body weight – IBW)