Table 1 Empirical antibiotic therapy protocol for HAP-VAP in ARC patients (CLCR > 150 ml/min)
Control period (June 2016 to November 2017) Conventional dosing regimen | Treatment period (November 2017 to January 2019) Increased dosing regimen | |
|---|---|---|
Early HAP-VAP (< 5 days of hospitalization) without risk factors for NF-GNB or multidrug-resistant pathogens | • Amoxicillin-clavulanic acid (2 g IV q 8 h) | • Amoxicillin-clavulanic acid (2 g IV q 6 h) |
• Cefotaxime (2 g IV q 8 h) | • Cefotaxime (2 g IV q 6 h) | |
• Ceftriaxone (2 g IV once/day) | • Ceftriaxone (2 g IV q 12 h) | |
Late HAP-VAP (≥ 5 days of hospitalization) and/or risk factors for NF-GNB or multidrug-resistant pathogens and/or immunosuppressive disease or therapy | Broad-spectrum β-lactam: | Broad-spectrum β-lactam: |
• Piperacillin-tazobactam (16 g/day continuously after a loading dose of 4 g) | • Piperacillin-tazobactam (20 g/day continuously after a loading dose of 4 g) | |
• Cefepime (6 g/day continuously after a loading dose of 2 g over 30 min) | • Cefepime (6 g/day continuously after a loading dose of 2 g over 30 mins) | |
• Ceftazidime (6 g/day continuously after a loading dose of 2 g over 30 min) | • Ceftazidime (6 g/day continuously after a loading dose of 2 g over 30 min) | |
• Meropenem (6 g/day continuously or 2 g q 8 h over 240 min) | • Meropenem (6 g/day continuously or 2 g q 8 h over 240 min) | |
If risk factors for MRSA | Gram-positive antibiotics with MRSA activity: glycopeptides (vancomycin 15 mg/kg/day continuously after a loading dose of 25 mg/kg*) or oxazolidinones (linezolid 600 mg IV twice/day) | |
If septic shock or ARDS at time of HAP-VAP | Aminoglycosides or fluoroquinolones: amikacine (20–30 mg/kg*), gentamycin (7–10 mg/kg*), or levofloxacin (500 mg twice/day) | |