Monotherapy of nosocomial pneumonia

Nosocomial pneumonia remains a common problem and is the leading cause of d eath among patients with nosocomial infection. However, the initial empiric therapy of nosocomial pneumonia is directed at the leading organisms commo n to all patients, and for many patients monotherapy is adequate for at lea st 48 hours, at which time the microbiological results of appropriate diagn ostic procedures should be known and the treatment can be focused. The curr ently available antimicrobial agents such as third- and fourth-generation c ephalosporins, piperacillin plus tazobactam, carbapenems, and some fluoroqu inolones are highly active and bactericidal. They should be used in conside ration of current pharmacodynamic knowledge, which will lead to convincing clinical results. Combination of antibiotics is necessary only in specific situations or for the amelioration of special pathogens, such as Pseudomona s aeruginosa, Acinetobacter spp., and against mixed aerobic and anaerobic i nfections.