Suspected staphylococcal pneumonia in patients with high-severity HAP
Consider adding vancomycin for patients with high-severity HAP who have either:
- microbiological evidence suggestive of staphylococcal pneumonia (eg profuse gram-positive cocci resembling staphylococci identified on Gram stain of a respiratory tract sample1)
- clinical features suggestive of staphylococcal pneumonia (eg cavitary pneumonia, pneumonia occurring after influenza, rapidly progressing pneumonia).
Consider adding to the empirical therapy regimen for high-severity HAP in adults and children:
vancomycin intravenously; for initial dosing, see Vancomycin dosing in adults or Intermittent vancomycin dosing for young infants and children. Loading doses are recommended for critically ill adults. vancomycin vancomycin vancomycin
Review therapy at 24 to 48 hours and consider stopping vancomycin based on the results of investigations – see Review of patients with high-severity HAP.
1 Gram stain of poor-quality respiratory samples can give misleading results. Ensure a good quality sample (collected before starting antibiotics) is used for adjusting therapy. A good quality sample is indicated by presence of polymorphs, but few or no squamous epithelial cells on microscopy.Return