18.3 Hospital-acquired pneumonia or Ventilator associated pneumonia
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| VAP | Piperacillin-tazobactam 4.5g IV q6h Or Cefoperazone- sulbactam 3g IV q12h | Meropenem 1g IV q8h Or Imipenem 500 mg IV q6h | All hospital onset infections; should be managed as per hospital antibiograms; these recommendations are general especially for places where there is no antibiogram (it is highly recommended to generate antibiograms). Change the empiric regimen based on susceptibility testing. Duration of therapy is 7 days |
| VAP in patients with recent exposure to BL- BLI / Carbapenems | Meropenem 1g q8h Or Imipenem 1g Stat and 500mg IV q6h Polymyxin B 15-20 lakhs units IV stat, followed by 7.5-10 lakhs IV q12h Or Colistin 9MU IV stat, then 4.5 MU IV q12h | Fosfomycin 4g IV q6h Or Tigecycline 200mg stat and 100mg IV BD Or Minocycline 200mg IV BD as add-on therapy to those mentioned in 1st column (based on local antibiogram) | Combination of Ceftazidime-avibactam 2.5 g iv q8h + Aztreonam 2 g IV q8h is discouraged for empiric use as there is resistance reported to this in E.coli and Pseudomonas spp.; it is intrinsically resistant to Acinetobacter baumannii. Targeted therapy should be used as sensitivity testing results of specimens from lower respiratory tract are available. Duration of therapy is 7 days |
For common etiological agents of Hospital-acquired pneumonia or Ventilator associated pneumonia, see Annexure B.18.3
Additional Information
- It is recommended that all hospitals regularly generate and disseminate a local antibiogram, ideally specific to their intensive care population.
References
1. Howroyd, F., Chacko, C., MacDuff, A. et al. Ventilator-associated pneumonia: pathobiological heterogeneity and diagnostic challenges. Nat Commun 15, 6447 (2024). https://doi.org/10.1038/s41467-024-50805-z
2. Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia, (2005) American Journal of Respiratory and Critical Care Medicine. American Thoracic Society – AJRCCM. doi: 10.1164/rccm.200405-644ST. https://doi.org/10.1164/rccm.200405-644ST
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5. Guidance on Diagnosis & Management of Carbapenem Resistant Gram-negative Infections. ICMR. 2022. Available from: https://www.icmr.gov.in/icmrobject/custom_data/pdf/resource-guidelines/Diagnosis_and_management_of_CROs.pdf