Template:Pneumonia Antibiotics: Difference between revisions
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**[[Doxycycline]] 100mg PO BID x 7-10 days OR | **[[Doxycycline]] 100mg PO BID x 7-10 days OR | ||
**[[Clarithromycin]] 500mg PO BID x 7-10 days | **[[Clarithromycin]] 500mg PO BID x 7-10 days | ||
===Inpatient=== | ===Inpatient=== |
Revision as of 05:56, 6 May 2015
Outpatient, community-acquired PNA
Coverage targeted at S. pneumoniae, H. influenzae. M. pneumoniae, C. pneumoniae, and Legionella
Healthy
- Clarithromycin XL 1000mg PO QD x7d OR
- Azithromycin 500mg PO day 1, 250mg on days 2-5 OR
- Doxycycline 100mg BID x 10-14d (2nd line choice)
Unhealthy
Chronic heart, lung, liver, or renal disease; DM, alcholism, malignancy.
- Levofloxacin 750mg QD x5d OR
- Moxifloxacin 400mg QD x7-14d OR
- Amoxicillin/Clavulanate 2g BID AND
- Azithromycin 500mg day 1, 250mg days 2-5 OR
- Doxycycline 100mg PO BID x 7-10 days OR
- Clarithromycin 500mg PO BID x 7-10 days
Inpatient
- Monotherapy or combination therapy is acceptable. Combination therapy includes a cephalosporin and macrolide targeting atypicals and Strep Pneumonia [1]
Community Acquired (Non-ICU)
Coverage against community acquired organisms plus M. catarrhalis, Klebsiella, S. aureus
- Levofloxacin 750mg IV/PO once daily OR
- Moxifloxacin 400mg IV/PO once daily OR
- Ceftriaxone 1g IV once daily PLUS
- Azithromycin 500mg IV/PO once daily OR
- Doxycycline 100mg IV/PO BID
Health Care-associated PNA
- 3-drug regimen recommended
- (Cefepime 1-2gm q8-12h OR ceftazidime 2gm q8h) + cipro 400mg q8h + vanco 15mg/kg q12 OR
- Imipenem 500mg q6hr + cipro 400mg q8hr + vanco 15mg/kg q12 OR
- Piperacillin-Tazobactam 4.5gm q6h + cipro 400mg q8h + vanco 15mg/kg q12
ICU, low risk of pseudomonas
- Ceftriaxone 1gm IV and Azithromycin 500mg IV OR
- Ceftriaxone 1gm IV and (moxifloxacin 400mg IV or levofloxacin 750mg IV)
- Penicillin allergy
- (Moxifloxacin or levofloxacin) + (aztreonam 1-2gm IV or clindamycin 600mg IV)
ICU, risk of pseudomonas
- Cefipime, Imipenem, OR Piperacillin/Tazobactam + IV cipro/levo
- Cefipime, imipenem, OR piperacillin-tazobactam + gent + azithromycin
- Cefipime, imipenem, OR piperacillin-tazobactam + gent + cipro/levo
- ↑ Chokshi R, Restrepo MI, Weeratunge N, Frei CR, Anzueto A, Mortensen EM. Monotherapy versus combination antibiotic therapy for patients with bacteremic Streptococcus pneumoniae community-acquired pneumonia. Eur J Clin Microbiol Infect Dis. Jul 2007;26(7):447-51