[Rational empiric antibiotic therapy of nosocomial pneumonia]

Antibiotic therapy is the method of choice for treatment of nosocomial pneumonia. It can be divided into empiric and specific therapy. First of them is based on predicting potential pathogens which may cause pneumonia. Important factors modifying the choice of initial empiric therapy are following: clinical history (e.g. time in hospital, type of hospital department, prior usage of antimicrobial agents), severity of pneumonia, presence of other risk factors and information given by direct microscopic examination of pulmonary secretions. Based on them it is frequently possible to select group of possible pathogens and then choose effective antibiotics with broad coverage. After a few days when specific etiology is found and antibiogram is performed antibiotic with narrow coverage should replace previous one. Specific therapy possesses several advantages when comparing with empiric therapy. It is more effective and cheaper. But necessity to wait a few days for the result of culture and its relatively low reliability are clear disadvantages.