VAP in patients at low risk of infection with Pseudomonas aeruginosa
Empirical therapy for ventilator-associated pneumonia (VAP) is stratified according to the risk of infection with Pseudomonas aeruginosa (see Approach to managing VAP).
For empirical therapy of VAP in adults and children at low risk of infection with P. aeruginosa, use:
1ceftriaxone 1 g (child 1 month or older: 50 mg/kg up to 1 g) intravenously, 12-hourly. See advice on patient review, intravenous to oral switch, duration of therapy and follow-up ceftriaxone ceftriaxone ceftriaxone
OR
1cefotaxime 2 g (child: 50 mg/kg up to 2 g) intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see cefotaxime dosage adjustment. See advice on patient review, intravenous to oral switch, duration of therapy and follow-up. cefotaxime cefotaxime cefotaxime
For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use ceftriaxone or cefotaxime (see dosages above).
For patients who have had a severe immediate1 hypersensitivity reaction to a penicillin, ceftriaxone or cefotaxime (at the dosages above) can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).
For patients who have had a severe immediate1 hypersensitivity reaction to a penicillin in whom ceftriaxone or cefotaxime is not used, or for patients who have had a severe delayed2 hypersensitivity reaction to a penicillin, use:
moxifloxacin 400 mg (child: 10 mg/kg up to 400 mg) intravenously, daily. For dosage adjustment in adults with kidney impairment, see moxifloxacin dosage adjustment. See advice on patient review, intravenous to oral switch, duration of therapy and follow-up. moxifloxacin moxifloxacin moxifloxacin