Lung - Hospital acquired

Suspected Microbes

Varies by setting

Initial Treatment

OR

  • 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

OR

  • 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

  • Homelessness

  • Incarcerated persons

  • Recent travel to or residing in an MRSA endemic region or community

Additional Information

Dose adjustment require in renal impairment for all above antimicrobials.

  • Use of IV antibiotics in the last 90 days

  • Immunosuppression

  • 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)

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