> 5 days of hospitalization AND/OR prior (≤ 3 months) broad spectrum antibiotics
Usual PathogensEnterobacterales
P. aeruginosa
S. aureus/MRSA
Stenotrophomonas maltophilia
Acinetobacter spp
| Empiric Therapy | Dose | Duration |
|---|---|---|
| [Piperacillin-tazobactam | 4.5g IV q6h | 7 days |
| or | ||
| Imipenem | 500mg IV q6h | |
| or | ||
| Meropenem] | 500mg IV q6h | |
| + | ||
| [Tobramycin | 7mg/kg IV q24h | 5 days |
| or | ||
| Ciprofloxacin IV/PO] | 400mg IV q8-12h/750mg PO bid |
If MRSA suspected, add:
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Vancomycin | 25-30mg/kg IV once then 15mg/kg IV q8-12h | Minimum 14 days for confirmed MRSA |
| or | ||
| Linezolid | 600mg IV/PO q12h | Minimum 14 days for confirmed MRSA |
Severe ß-lactam allergy
| Empiric Therapy | Dose | Duration |
|---|---|---|
| [Vancomycin | 25-30mg/kg IV once then 15mg/kg IV q8-12h | Minimum 14 days for confirmed MRSA |
| or | ||
| Linezolid] | 600mg IV/PO q12h | Minimum 14 days for confirmed MRSA |
| + | ||
| Ciprofloxacin IV/PO | 400mg IV q8-12h/750mg PO bid | 7 days |
| + | ||
| Tobramycin | 7mg/kg IV q24h | 5 days |