Common organisms
- • Pseudomonas
- • MRSA
- • ESBL Enterobacterales
- • Acinetobacter
Empirical therapy
- • Piperacillin-tazobactam 4.5 g IV q8h + Vancomycin (if MRSA risk)
- • Add aminoglycoside if septic shock or local MDR risk
Culture-directed
- • Per culture and sensitivity
- • Pseudomonas: dual cover initially, de-escalate
Adverse effects
- • Nephrotoxicity (aminoglycoside, vancomycin)
- • Red-man syndrome (vanco infusion)
Monitoring
- • Vanco trough 15-20 mg/L for HAP
- • Daily RFT, drug levels
Clinical pearls
- • Local antibiogram dictates choice
- • Duration 7 days unless complicated
Educational support only — follow local antibiogram and institutional protocols.
