• Do not escalate or change antibiotics unless 72 hours after last change
• Typically like attendings like to treat with IV gram- coverage for 7 days if able (at times if patient wants to go home can transition to coverage like cipro which has good penetrance into blood)
• For patients who are elderly or frail, can consider Zosyn over cefepime to avoid risk of cefepime-induced neurotoxicity
• When escalating from Zosyn to include Vancomycin for MRSA coverage, consider transitioning to either vancomycin + cefepime or vancomycin + cefepime + metronidazole (if need anaerobic coverage) to avoid vanc + zosyn nephrotoxicity