Antimicrobial Stewardship
- 7 days
- Evidence shows 7 days can be appropriate for Pseudomonas
- Immunocompromised patients may need 10 days
- Complications (e.g., empyema, lung abscess), slow response, or concomitant bacteremia may warrant a longer duration
- When possible, narrow antibiotic therapy based on culture results
- Vancomycin can usually be stopped if MRSA is not isolated on culture and/or screening swabs
- Narrow coverage if Pseudomonas is not isolated
- If patient is on double Pseudomonas coverage the second agent can often be discontinued once the patient is clinically improved or a pathogen is identified
- Do not repeat cultures if patient is improving; cultures may continue to be positive in ventilated patients despite successful treatment due to colonization
- Antibiotics with good oral bioavailability should be administered orally unless contraindicated (e.g., metronidazole, ciprofloxacin, levofloxacin)