This handout is for hospital-acquired & ventilator-associated pneumonia (hap / vap, non-covid). Your care team identified this based on: new fever + purulent endotracheal / sputum secretions in hospitalised patient — idsa/ats 2016 kalil (pmid 27418577).
Other reasons your team may use this plan: new or progressive radiographic infiltrate ≥48 h after admission / intubation (the necessary pivot — no new infiltrate → not hap/vap, consider vat) — idsa/ats 2016 kalil; rising fio2 / peep / new hypoxemia in ventilated patient (ventilator-associated event) — idsa/ats 2016 kalil; new leukocytosis (≥12) or leukopenia (≤4) with respiratory deterioration — idsa/ats 2016 kalil.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| piperacillin-tazobactam | 4.5 g IV q6h (extended 4 h infusion preferred); renal: CrCl 20-40 → 3.375 g q6h, CrCl <20 → 2.25 g q6h; HD supplement post-dialysis | IV | q6h | Single anti-pseudomonal β-lactam covers GNR + MSSA — IDSA/ATS 2016 Kalil. RxCUI 74169 RxNav-confirmed 2026-05-16 = "piperacillin / tazobactam" (corrected from prior erroneous 18631 = azithromycin). |
| cefepime | 2 g IV q8h; renal: CrCl 30-60 → 2 g q12h, CrCl 11-29 → 2 g q24h, CrCl <11 → 1 g q24h (neurotoxicity risk if under-adjusted in renal failure) | IV | q8h | Anti-pseudomonal cephalosporin alternative — IDSA/ATS 2016 Kalil. RxCUI 20481 RxNav-confirmed 2026-05-16 = cefepime. |
| levofloxacin | 750 mg IV daily; renal: CrCl 20-49 → 750 mg q48h, CrCl <20 → 750 mg ×1 then 500 mg q48h | IV | daily | Reserve when β-lactam contraindicated (FDA 2018 tendon/aortic/neuropathy boxed warning) — IDSA/ATS 2016 Kalil. RxCUI 82122 RxNav-confirmed 2026-05-16 = levofloxacin. |
Plan: IDSA/ATS 2016 HAP/VAP empirical antibiotics — risk-stratified
Call 911 or go to the nearest emergency room right away if you have:
Total 7-day duration if responding (Chastre non-inferior mortality 18.8% vs 17.2%, more antibiotic-free days, less MDR among recurrences — PMID 14625336; Pugh +4.02 antibiotic-free days, MDR recurrence OR 0.44 — PMID 26301604). Extend to 10-14 d ONLY for non-fermenting GNR (Pseudomonas/Acinetobacter — Chastre NF-GNB recurrence 40.6% vs 25.4%; Pugh OR 2.18), structural lung disease, immunocompromise, empyema/abscess, or slow response. Reinforce VAP prevention bundle; post-ICU follow-up
Guideline: IDSA/ATS 2016 HAP/VAP CPG (Kalil; PMID 27418577; current US standard 2026) + ERS/ESICM/ESCMID/ALAT 2017 (PMID 28890434) + Surviving Sepsis Campaign 2021 (Evans; PMID 34599691)