What is the empiric therapy regimen for patients with community-acquired pneumonia (CAP) in the ICU?

Updated: Oct 28, 2019
  • Author: Fariba M Donovan, MD, PhD; Chief Editor: Thomas E Herchline, MD  more...
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See the list below:

  • Combination of a beta-lactam (ceftriaxone 1 g IV q24h or  cefotaxime 1 g IV q8h or  ceftaroline 600 mg IV q12h) plus
  • Azithromycin 500 mg IV q24h or
  • Levofloxacin 750 mg IV or PO q24h or
  • Moxifloxacin 400 mg IV or PO q24h or

If gram-negative rod pneumonia (Pseudomonas) suspected, due to alcoholism with necrotizing pneumoniae, chronic bronchiectasis/tracheobronchitis due to cystic fibrosis, mechanical ventilation, febrile neutropenia with pulmonary infiltrate, septic shock with organ failure:

  • Piperacillin-tazobactam 4.5 g IV q6h or 3.375 g IV q4h or  4-h infusion of 3.375 g q8h or
  • Cefepime 2 g IV q12h or
  • Imipenem/cilastatin 500 mg IV q6h or  meropenem 1 g IV q8h plus
  • Levofloxacin 750 mg IV q24h or
  • Moxifloxacin 400 mg IV or PO q24h or
  • Azithromycin 500 mg IV q24h

Aminoglycoside (gentamicin 7 mg/kg/day IV or tobramycin 7 mg/kg/day IV) was included in older guidelines but is not included in newer guidelines for empiric therapy

Duration of therapy: 10-14 days

If concomitant with or post influenza, add:

  • Vancomycin 15 mg/kg IV q12h or
  • Linezolid 600 mg IV bid

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