- Healthcare-associated pathogens (Pseudomonas aeruginosa · resistant gram-negative bacilli · Staphylococcus aureus (including MRSA) · Enterobacteriaceae)
First-line therapy
Ampicillin/sulbactam • i.v. • 50–50 mg/kg/dose • 4×/day
Dose is calculated using the ampicillin component.
Max 2000 mg/dose (ampicillin) · Duration: 7 days
Enter weight on Kids to calculate doses
Cefepime • i.v. • 50–50 mg/kg/dose • 3×/day
Max 2000 mg/dose · Duration: 7 days
- • Cefepime: antipseudomonal coverage when Pseudomonas or other resistant gram-negative bacilli are suspected.
- • Piperacillin/tazobactam: broader gram-negative and anaerobic coverage; polymicrobial or ICU-associated HAP.
- • Meropenem: suspected ESBL-producing organisms, severe infection, or beta-lactam allergy when carbapenem is appropriate.
- • Vancomycin: add when MRSA risk, positive MRSA screen, or severe/ventilator-associated HAP per local protocol; monitor levels.
- • Linezolid: MRSA-targeted therapy when vancomycin is unsuitable; adolescents ≥12 years — 600 mg IV or PO 2×/day (not weight-based).
Enter weight on Kids to calculate doses
Clinical notes
- • Use local antibiogram when available.
- • Obtain cultures before antibiotics if feasible.
- • Reassess at 48–72 h and de-escalate based on cultures.
- • Escalate to antipseudomonal or anti-MRSA therapy when clinically indicated.
- • Adjust all doses for renal impairment per local protocol.
- • AAP Red Book — Pneumonia and Antimicrobial Therapy (2024)
- • PIDS/IDSA Clinical Practice Guideline — Pediatric CAP (principles applicable) (2011)
- • ESPID Guideline (2024)
+ 2 more
- • NICE NG139 — Hospital-acquired pneumonia antimicrobial prescribing (2019)
- • WHO EMLc hospital-acquired pneumonia antibiotic options (2023)
