Respiratory Infections
Severe

Severe

Microbiology

First Line Treatment

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If patient at risk for MSSA OR MRSA (see clinical considerations below)

  • Vancomycin dosing recommendations are based on 70kg patient with normal renal function; (recommended dose 15-20 mg/kg/dose unless otherwise stated)
  • Please contact pharmacy for patients requiring vancomycin or aminoglycoside monitoring

Second Line Treatment

750mg PO q12h OR 400mg IV q8-12h

+/-

If MRSA risk factors (see clinical considerations below)

  • Vancomycin dosing recommendations are based on 70kg patient with normal renal function; (recommended dose 15-20 mg/kg/dose unless otherwise stated)
  • Please contact pharmacy for patients requiring vancomycin or aminoglycoside monitoring

Duration of Therapy

7-8 days

S. aureus infections: Longer duration required, 14 days

P. aeruginosa infections: Longer duration frequently required, 10-14 days

Clinical Considerations

  • Colonization with MRSA
  • Injection drug user
  • History of substance abuse
  • Homeless in the last year
  • From crowded living conditions

Suspect if:

  • Colonized with P. aeruginosa

OR

  • Has at least 2 of the following:
    • Recent hospitalization
    • Frequent (>4 per year) or recent course of antibiotics (last 3 months)
    • Severe disease
    • Prolonged high dose steroid use
  • Response to therapy usually occurs at 48-72 hrs.
  • Monitor for decrease in temperature, WBC, oxygenation requirements, sputum purulence, and improvement in hemodynamics
  • When culture and susceptibility results are available, pathogen-directed therapy should be used
  • Switch IV to PO when
    • a. hemodynamically stable AND
    • b. improving clinically AND
    • c. able to tolerate PO AND
    • d. have a normal functioning GI tract