Hospital-Acquired Pneumonia (2009)

Transcription

1 Hospital-Acquired Pneumonia (2009) Philippine Hospital Infection Control Society (PHICS) 2nd Floor, PSMID Bldg., 116 9th Avenue, Cubao, Quezon City Telephone o.: Fax o.: Website:

2 Philippine Hospital Infection Control Society (PHICS) 2nd Floor, PSMID Bldg., 116 9th Avenue, Cubao, Quezon City Telephone o.: Fax o.: Website: Board Members President Vice-President Secretary Assistant Secretary Treasurer Auditor Board Members Bernadette T. Seludo, MD Primo B. Valenzuela, MD Evengelita A. America, R Caroline V. Molina, R Victoria I. Ching, R Ma. Carmen SG. Buenaflor, R Regina P. Berba, MD Victoria D. Villanueva, R Maria Fe Raymundo-Tayzon, MD l Sign up and open your clinic to the world. 133

3 Algorithm 1 - Diagnostic Approach and Management of HAP/VAP* HAP/ VAP Suspect 1. Fever 2. Leucocytosis 3. Purulent sputum AD ew or worsening infiltrates on Chest X-ray 1st 4 to 6 hours Blood C/S G/S & C/S of : Sputum or tracheal aspirate or pleural fluid Start empiric antibiotic therapy (See algorithm 2) 48 to 72 hours: Check cultures & assess clinical response (temperature, WBC, CXR, oxygenation, purulent sputum, hemodynamic changes & organ function) Clinical improvement at hrs? a. De-escalate antibiotic if possible b. Treat selected patients for 7-8 days and reassess Culture (+)? a. Adjust antibiotic therapy b. Search for: other pathogen, complications, other diagnoses or other sites of infection a. Search for: other pathogens, complication, other diagnoses, or other sites of infection b. Consider: referral to a specialist, FOB/ BAL, PSB *Hospital-acquired pneumonia/ventilator-associated pneumonia 134

4 Algorithm 2 - Empiric Treatment of Hospital - Acquired Pneumonia / VAP HAP/ VAP Is it a Late-onset? 5 days HIGH RISK HAP/VAP FOR MDRO* History of Antibiotic Intake? Low Risk HAP/VAP/HCAP for MDRO * MDRO - multi-drug resistant organism Learn to access drug info on your cellphone. Send PPD to 2600 for Globe/Smart/Sun users. 135

5 Recommended Empiric Antibiotic Therapy* for HAP/VAP with Low Risk for MDRO (early onset < days, no prior antibiotic intake) on-anti-pseudomonal ß-lactam Agent with or without anaerobic coverage on-anti-pseudomonal agent with anaerobic coverage IV Ampicilin-Sulbactam, Ertapenem on-anti-pseudo ß-lactam agent w/out anaerobic coverage IV Ceftriaxone If allergic to ß-lactam a. IV Levofloxacin, Moxifloxacin b. Clindamycin + Aztreonam / Aminoglycoside Recommended Empiric Antibiotic Therapy* for HAP/VAP with High Risk for MDRO (late onset 5 days, with or without prior intake early onset with prior antibiotic intake) Anti-Pseudomonal ß-lactam Agent with or without anaerobic coverage+/- Aminoglycoside or Anti-Pseudomonal Fluoroquinolone +/- Anti-MRSA agent Anti-Pseudomonal ß-lactam agent without anaerobic coverage Cefepime, Ceftazidime Anti-Pseudomonal ß-lactam agent with anaerobic coverage Cefoperazone-sulbactam, Ticarcillin-clavulanic acid, Piperacillin-Tazobactam, Imipenem-cilastatin, Meropenem Aminoglycoside Amikacin, Gentamycin, Tobramycin, etilmicin Anti-Pseudomononal Fluoroquinolones Ciprofloxacin, Levofloxacin Anti-MRSA agent Vancomycin, Linezolid, Tigecycline * Final choice of antibiotics is according to the hospitals' antibiogram, formulary and policy 136

6 Index of Drugs Mentioned in the Guideline Hospital-Acquired Pneumonia This index lists the products and/or their therapeutic classifications mentioned in the guideline. For the doctor's convenience, brands available in the PPD references are listed under each of the classes. For drug information, refer to the PPD references (PPD, PPD Pocket Version, PPD Text, PPD Tabs, and Aminoglycosides Amikacin Amikacide Kormakin Gentamicin Agentam Genom Servigenta etilmicin Tobramycin Carbapenems Ertapenem Invanz Imipenem-Cilastatin Tienam Meropenem Merix Meromax Meronem Merop Cephalosporin Ceftazidime Cefatzivit Fortum Onetazid Pharex Ceftazidime Powder for Inj Sefta Spexil Tazim Zeptrigen IV Ceftriaxone Bactrias Ceftrialis Cepner Cotenzo Eluxone Forgram Keptrix Megion Oncef Pantrixon Pharex Ceftriaxone Powder for Inj Pneumosolv Retrokor Rocephin Seltroz Supraxone Torocef Triaxon Plus Tricexone Ty-Oxone Cefoperazone-Sulbactam Sulperazone Cefepime Axera Cepiram Dimipra Forcepime Pozineg 1000 Sanpime Vipefime Clindamycin-Aztreonam Penicillins IV Ampicillin-Sulbactam Ambacitam Ampico-SBT Ampimax Miasyn Silgram Sulbacillin Unasan Unasyn IM/IV Unasyn RTU Piperacillin-Tazobactam Paizu Peprasan-T Piptaz Pletzolyn Tazocin Tebranic Vigocid Ticarcillin-Clavulanic Acid Timentin Triclav Quinolones Ciprofloxacin Ciclodin Cifloxin Ciprobay/Ciprobay XR Ciprofen Ciprofloxacin Sandoz Cipromax Cipromet Cipromet I.V. Cirok Ciprotor Ciprotor IV Ciprozef Cirok Cobay Hyprocel Ipromax Medicip Orpic Pharex Ciprofloxacin Proxxen Qinosyn-500 Quiprime Rapiqure Ritemed Ciprofloxacin Sahar Ciprofloxacin 2mg/ml Solution for Intravenous Infusion Savedar Sigmacip Sricipro Winthrop Ciprofloxacin Xenoflox Xipro Ziprocap Zyflox Zyprolan Levofloxacin Flevoxcin Floxel Floxiprime l Sign up and open your clinic to the world. Glevo Lefloxin Levan Levex Levflox Levocin Levonex Levoprime Levoquin Levores Film-coated Tablet Levores Solution for IV Infusion Levox Levozef Lexyl-OD Lezasin Loxeva Ovel Pharex Levofloxacin Pneumocal Santis Teravox Terlev Wilovex Winthrop Levofloxacin Moxifloxacin Avelox Moxiflox Other Antibiotics Linezolid Zyvox Tigecycline Tygacil Vancomycin Vancocin CP Vancomet 137