New therapeutic approaches to hospital-acquired pneumonia.

Conventional therapy of hospital-acquired pneumonia includes intravenous antibiotics and supportive care. In many cases, the etiologic agent of infection is not clear; thus, empiric broad-spectrum antibiotic regimens are commonly used. Combinations of beta-lactam and aminoglycoside agents are particularly popular regimens due to the high incidence of gram-negative bacillary and Staphylococcus aureus pneumonias in the hospital setting. Several new approaches to treatment of nosocomial pneumonias are currently being evaluated, however. These include: single-agent empiric coverage using a broad-spectrum beta-lactam agent; intrabronchial aminoglycoside instillation therapy; oral quinolone agents for treatment of gram-negative bacillary pneumonia; and passive immune therapy. The current experience and potential future role of these therapeutic options are discussed in this chapter.