Weissbuch Version August 2013

6. Reevaluation im Verlauf / Therapiedauer
Reevaluation der empirischen antibiotischen Therapie nach
2 und 3 Tagen resp. nach Erhalt der mikrobiologischen Resultate
gemäss adaptiertem ATS Algorithmus (1)
Prinzip:
Klinischer / Radiologischer Verdacht → mikrobiologisches
Sampling → Reevaluation der Resultate → Anpassen der antibiotischen
Therapie (De-Eskalation)
HAP, VAP or HCAP Suspected
Obtain Lower Respiratory Tract (LRT) Sample for Culture
(Quantitative or Semi-quantitative) & Microscopy
Unless There Is Both A Low Clinical Suspicion for
Pneumonia & Negative Microscopy of LRT Sample, Begin Empiric
Antimicrobial Therapy Using Algorithm in Figure 2* & Local
Microbiologic Data
Days 2 & 3: Check Cultures & Assess Clinical Response:
(Temperature, WBC, Chest X-ray, Oxygenation, Purulent Sputum,
Hemodynamic Changes & Organ Function)
Clinical Improvement at 48 –72 Hours
*
< 5 days and
no risk
Factors
Amoxi/Clav
1.2 g i.v./8 h
OR
Ceftriaxon 2 g
i.v./24 h
≥ 5 days or
risk factors
Pip/Tazo 4.5 g
i.v./8 h
OR
Cefepime 2 g
i.v./ 12 h
Cultures –
NO
Cultures +
Cultures –
YES
Cultures +
Search for Other
Pathogens,
Complications,
Other Diagnoses
or
Other Sites
of Infection
Adjust Antibiotic
Therapy, Search for
Other Pathogens,
Complications,
Other Diagnoses or
Other Sites of
Infection
Consider
Stopping
Antibiotics
De-escalate
Antibiotics,
if Possible.
Treat Selected
Patients
for 7-8 Days
& Reassess
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