Despite aggressive efforts to reduce nosocomial infections, many intubated patients develop ventilator-associated pneumonia (VAP). VAP has been an area of intense research; however, there is still little consensus in the literature on how to accurately diagnose or treat VAP. VAP complicates the course of 8 - 28% of mechanically ventilated patients and mortality varies greatly from 8 to 76%, depending on the specific population being studied. Once pneumonia is suspected, bacteriologic confirmation should be obtained and empiric therapy must be instituted as soon as possible, as a delay in therapy or inappropriate therapy greatly increases mortality. Initial antibiotic therapy should be based on the most common organisms in each hospital or unit, and the most likely pathogens for that specific patient. Constant surveillance of the responsible pathogens through the use of antibiograms allows clinicians to make educated choices for antibiotics. When final cultures and sensitivities are available, de-escalation to less broad spectrum antibiotics should be performed. If cultures show no bacterial growth, antibiotics should be discontinued so that patients are not exposed to unnecessary antibiotics. Following these practices will help to decrease multi-resistant strains of bacteria and can improve the morbidity and mortality of VAP.