To avoid prolonged use of broad-spectrum antibiotics, it is essential to de-escalate therapy according to the results of microbiologic analyses

For patients with HAP requiring intubation, a culture of endotracheal secretions is recommended

• Empiric coverage of atypical organisms (e.g. Legionella, Mycoplasma) is generally not recommended
• Consider atypical coverage if nosocomial outbreak of Mycoplasma or Legionella

• Empiric double coverage of Pseudomonas aeruginosa to maximize the likelihood of having at least one active agent (due to increased risk of resistance with Pseudomonas).
• If Pseuodomonas is isolated, step-down to monotherapy (according to susceptibility data)
• Use of aminoglycosides (e.g. tobramycin and gentamicin) as monotherapy for the treatment of pneumonia is NOT recommended (even if susceptibility is confirmed)

• DO NOT use DAPTOmycin to treat pneumonia; DAPTOmycin is inactivated by pulmonary surfactant.
• If MRSA infection, use vancomycin (or linezolid if vancomycin is ineffective or inappropriate)