III. HEALTH CARE-ASSOCIATED PNEUMONIA (HAP): Hospital or Nursing Home-acquired, Ventilator-associated, Hemodialysis, Immunosuppressive Disease, Antibiotics within prior 90 days:
• Cefepime 2gm q12h, PLUS [Tobramycin (ODA)
or Cipro 400mg IV q 8h; either x 3-5 days],
PLUS Vancomycin 1-1.5gm q 12-24h (trough 15-
20ug/ml: D/C Vancomycin if cultures negative
for MRSA/MRSE at 48 hr).
• Aspiration: Add Flagyl 500mg q 12h to the above; OR, Zosyn 4.5gm q 6h, PLUS Vancomycin (as above).
• Streamlining: change to narrower-spectrum monotherapy based on microbiology results.
• Duration of therapy for HAP = 8 days (14d if Pseudomonas).