What are the guidelines for antibiotic therapy for ICU patients with pneumonia and sepsis/septic shock?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

For inpatients with pneumonia who are admitted to the ICU, the IDSA/ATS guidelines offer the following minimal recommendations [66] :

  • Administer a beta-lactam (eg, cefotaxime, ceftriaxone, ampicillin-sulbactam) plus either azithromycin or a fluoroquinolone; penicillin-allergic patients may receive a respiratory fluoroquinolone and aztreonam

  • For pseudomonal infections, administer (1) an antipneumococcal, antipseudomonal beta-lactam agent (eg, piperacillin-tazobactam, cefepime, imipenem, or meropenem) plus ciprofloxacin or levofloxacin; (2) the beta-lactam above plus an aminoglycoside and azithromycin; or (3) the beta-lactam above plus an aminoglycoside and an antipneumococcal fluoroquinolone (for penicillin-allergic patients, use aztreonam instead of the above beta-lactam)

  • Add vancomycin or linezolid for patients with community-acquired MRSA (CA-MRSA) infection


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