Template:Pneumonia Antibiotics

Outpatient, community-acquired PNA

Healthy

1. Clarithromycin XL 1000mg PO QD x7d OR
2. Azithromycin 500mg PO day 1, 250mg on days 2-5 OR
3. Doxycycline 100mg BID x 10-14d (2nd line choice)

Unhealthy

1. Chronic heart, lung, liver, or renal disease; DM, alcholism, malignancy.  Add
   1. Levofloxacin 750mg QD x5d OR
   2. Moxifloxacin 400mg QD x7-14d OR
   3. Amoxicillin/Clavulanate 2g BID AND Azithromycin 500mg day 1, 250mg days 2-5 OR Doxy
   4. 3rd generation cephalosporin AND Azithromycin or Doxycycline

Inpatient

• Monotherapy or combination therapy is acceptable. Combination therapy includes a cephalosporin and macrolide targeting atypicals and Strep Pneumonia

Community-acquired PNA

1. Levofloxacin 750mg QD x5d OR
2. Moxifloxacin 400mg QD x7-14d OR
3. 3rd generation cephalosporin AND azithromycin OR doxycycline

Health Care-associated PNA

1. 3-drug regimen recommended
   1. (Cefepime 1-2gm q8-12h OR ceftazidime 2gm q8h) + cipro 400mg q8h + vanco 15mg/kg q12 OR
   2. Imipenem 500mg q6hr + cipro 400mg q8hr + vanco 15mg/kg q12 OR
   3. Piperacillin-Tazobactam 4.5gm q6h + cipro 400mg q8h + vanco 15mg/kg q12

ICU, low risk of pseudomonas

1. Ceftriaxone 1gm IV and Azithromycin 500mg IV OR
2. Ceftriaxone 1gm IV and (moxifloxacin 400mg IV or levofloxacin 750mg IV)
3. Penicillin allergy
   1. (Moxifloxacin or levofloxacin) + (aztreonam 1-2gm IV or clindamycin 600mg IV)

ICU, risk of pseudomonas

1. Cefipime, Imipenem, OR Piperacillin/Tazobactam + IV cipro/levo
2. Cefipime, imipenem, OR piperacillin-tazobactam + gent + azithromycin
3. Cefipime, imipenem, OR piperacillin-tazobactam + gent + cipro/levo