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