Table 3 Recommended therapy for suspected or confirmed multidrug resistant organisms and fungal VAP [1], [34], [35], [41]

Methicillin-resistant Staphylococcus aureus (MRSA)

See Table 2

Pseudomonas aeruginosa

Double coverage recommended. See Table 2

Acinetobacter species

Carbapenem

e. g., imipenem + cilastin; 1 g every 8 hours;

meropenem 1 g every 8 hours

OR

Beta-Lactam/beta-lactamase inhibitor

e. g., ampicillin + sulbactam: 3 g every 8

hours

OR

Tigecycline: 100 mg loading dose, then 50 mg every 12 hours

Extended-spectrum beta-lactamase (ESBL) positive enterobacteriaceae

Carbepenem

e. g., imipenem + cilastin: 1 g every 8 hours;

meropenem: 1 g every 8 hours

Fungi

Fluconazole: 800 mg every 12 hours;

caspofungin: 70 mg loading dose, then 50 mg daily;

voriconazole (for aspergillus species): 4 mg/kg every 12 hours

Legionella

Macrolides (e. g., azithromycin)

OR

Fluoroquinolones (e. g., levofloxacin)