Prescription of antimicrobial therapy for NHAP remains a highly contested issue driven by a disagreement on how the condition should be approached and treated. Should NHAP be recognized as CAP, health-care-associated pneumonia, or hospital-acquired pneumonia? The arguments for and against the inclusion of NHAP in these classifications are beyond the context of this review. Despite the fact that respiratory tract infections remain the primary cause for use of antimicrobial therapy in nursing homes,25 the lack of randomized trials has been a continuous problem for expert panels developing guidelines. The two guidelines that have addressed treatment of pneumonia in the nursing home setting have been consistent in their approach to antibiotic therapy.26,27 The choices for empirical coverage include oral antipneumococcal quinolone alone, amoxicillin/clavulanic acid, or a second-generation oral cephalosporin plus a macrolide other than erythromycin. For residents who develop NHAP not amenable to oral treatment, once-daily IM therapy with ceftriaxone vs cefepime has been examined in a double-blind study with similar efficacy.28 However, in the absence of outcome data pointing to a superiority of one regimen over another, the choice of treatment depends on knowing the potential pathogens, likelihood of antibiotic resistance, ease of administration, and adverse effect profiles of various agents. Modifying risk factors suggestive of multidrug-resistant organisms include a history of resistant pathogens, antibiotic therapy in the past 3 months, foreign bodies, chronic wounds, recent hospitalization, and dependency on or need for contact care.29,30 One study noted that the 75th percentile for duration of therapy of NHAP within the nursing home was 10 days,31 but the optimal duration of antibiotic treatment is unknown.