HAP and VAP
Follow Up

Follow Up

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)