Antibiotic Selection for Bronchopneumonia

Hospital-Acquired Bronchopneumonia

For low-risk patients without MRSA risk factors, the Infectious Diseases Society of America recommends piperacillin-tazobactam, cefepime, or levofloxacin as first-line options 1, 3
For high-risk patients, dual therapy with an antipseudomonal beta-lactam and a fluoroquinolone or aminoglycoside is required 1, 3, 4
MRSA coverage with vancomycin or linezolid is indicated for patients with recent IV antibiotics, high mortality risk, or unknown unit MRSA prevalence 1, 3, 4

For hospitalized non-severe CAP, combination therapy with a beta-lactam and a macrolide, or monotherapy with levofloxacin or moxifloxacin, is recommended 2, 5, 6
For severe CAP, non-antipseudomonal cephalosporin III plus a macrolide, or moxifloxacin/levofloxacin with or without a cephalosporin III, is recommended 2, 5
For CAP patients with Pseudomonas risk factors, antipseudomonal cephalosporin, piperacillin-tazobactam, or carbapenem, plus ciprofloxacin or a macrolide and an aminoglycoside, is recommended 2, 4

The treatment duration for CAP should not exceed 8 days in responding patients 2, 5
IV-to-oral switch criteria include clinical stability and no need for hospital observation after oral switch 2, 4