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

From: Ventilator-associated pneumonia in the ICU

Pathogen Treatment
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)