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Table 2 Comparison of recommended initial empiric therapy for ventilator-associated pneumonia (VAP) according to time of onset [1], [34], [41]

From: Ventilator-associated pneumonia in the ICU

Early-onset VAP Late-onset VAP
Second or third generation cephalosporin: e. g., ceftriaxone: 2 g daily; Cephalosporin
cefuroxime: 1.5 g every 8 hours; e. g., cefepime: 1-2 g every 8 hours;
cefotaxime: 2 g every 8 hours ceftazidime 2 g every 8 hours
OR OR
Fluoroquinolones Carbepenem
e. g., levofloxacin: 750 mg daily; e. g., imipenem + cilastin: 500 mg every 6 hours or 1 g every 8 hours;
moxifloxacin: 400 mg daily meropenem: 1 g every 8 hours
OR OR
Aminopenicillin + beta-lactamase inhibitor e. g., ampicillin + sulbactam: 3 g Beta-lactam/beta-lactamase inhibitor
every 8 hours e. g., piperacillin + tazobactam: 4.5 g every 6 hours
OR PLUS
Ertapenem Aminoglycoside
1 g daily e. g., amikacin: 20 mg/kg/day;
  gentamicin: 7 mg/kg/day;
  tobramycin: 7 mg/kg/day
  OR
  Antipseudomonal fluoroquinolone
  e. g., ciprofloxacin 400 mg every 8 hours;
  levofloxacin 750 mg daily
  PLUS
  Coverage for MRSA
  e. g., vancomycin: 15 mg/kg every 12 hours
  OR
  linezolid: 600 mg every 12 hours
  1. Optimal dosage includes adjusting for hepatic and renal failure. Trough levels for vancomycin (15-20 mcg/ml), amikacin (< 5 mcg/ml), gentamicin (< 1 mcg/ml) and tobramycin (< 1 mcg/ml) should be measured frequently to avoid untoward systemic side eff ects. All recommended doses are for intravenous infusion. Usual duration of therapy is 8 days unless treatment is for multidrug resistant organisms, in which case treatment will be for 14 days.