EUH Resident Report: What are the current guidelines for treating non-CAP pneumonia?

The Bottom Line: Treatment guidelines for hospital-acquired aspiration pneumonia

  • no definitive evidence to inform optimal antibiotic regimen
  • antibiotic choice typically based on setting and concern for anaerobic infection
  • treatment should be based on suspected pathogens
  • pathogenic role of anaerobes and need for coverage is unclear
    • options, with anaerobic coverage, include (dosing for adults with normal renal function)
      • piperacillin-tazobactam 4.5 g every 6 hours or
      • an antipseudomonal carbapenem, such as meropenem 1 g every 8 hours or
      • an antipseudomonal cephalosporin, such as cefepime 1-2 g every 8-12 hours plus metronidazole 500 mg IV every 8 hours
    • plus consideration of vancomycin 15 mg/kg every 12 hours (adjusted to troughs of 15-20 mcg/mL)
  • optimal duration of therapy for hospital-acquired aspiration pneumonia not determined but 7-8 day course is recommended for most patients with hospital-acquired pneumonia apart from those with infection with nonfermenting gram-negative bacilli, such as Pseudomonas spp.

(DynaMed Plus, 2015)

References: DynaMed Plus [Internet]. Ipswich (MA): EBSCO Information Services. 1995 – . Record No. 116655, Aspiration pneumonia; [updated 2015 Aug 12, cited 2017 July 11.]

Kalil AC, Meteresky ML, Klompas M, Muscedere J, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clinical Infectious Diseases. 2016 Sep 1;63(5):e61-e111. doi:10.1093/cid/ciw353.

Summary:  The Infectious Diseases Society of America and the American Thoracic Society present the following recommendations in their 2016 clinical practice guidelines (Kalil et al, 2016):

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