Template:Pneumonia Antibiotics: Difference between revisions

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===Outpatient, community-acquired PNA===
===Outpatient, community-acquired PNA===
''Coverage targeted at [[S. pneumoniae]], [[H. influenzae]]. [[M. pneumoniae]], [[C. pneumoniae]], and [[Legionella]]
====Healthy====
====Healthy====
#[[Clarithromycin]] XL 1000mg PO QD x7d OR
*[[Clarithromycin]] XL 1000mg PO QD x7d OR
#[[Azithromycin]] 500mg PO day 1, 250mg on days 2-5 OR
*[[Azithromycin]] 500mg PO day 1, 250mg on days 2-5 OR
#[[Doxycycline]] 100mg BID x 10-14d (2nd line choice)
*[[Doxycycline]] 100mg BID x 10-14d (2nd line choice)


==== Unhealthy ====
==== Unhealthy ====
#Chronic heart, lung, liver, or renal disease; DM, alcholism, malignancy.  Add
'''Chronic heart, lung, liver, or renal disease; DM, alcholism, malignancy.'''
##[[Levofloxacin]] 750mg QD x5d OR  
*[[Levofloxacin]] 750mg QD x5d OR  
##[[Moxifloxacin]] 400mg QD x7-14d OR  
*[[Moxifloxacin]] 400mg QD x7-14d OR  
##[[Amoxicillin/Clavulanate]] 2g BID AND [[Azithromycin]] 500mg day 1, 250mg days 2-5 OR [[Doxy]]
*[[Amoxicillin/Clavulanate]] 2g BID AND
##3rd generation [[cephalosporin]] AND [[Azithromycin]] or [[Doxycycline]]
**[[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===
===Inpatient===
*Monotherapy or combination therapy is acceptable. Combination therapy includes a cephalosporin and macrolide targeting atypicals and Strep Pneumonia <ref>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</ref>
*Monotherapy or combination therapy is acceptable. Combination therapy includes a cephalosporin and macrolide targeting atypicals and Strep Pneumonia <ref>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</ref>
====Community-acquired PNA====
 
#[[Levofloxacin]] 750mg QD x5d OR
====Community Acquired (Non-ICU)====
#[[Moxifloxacin]] 400mg QD x7-14d OR
''Coverage against community acquired organisms plus [[M. catarrhalis]], [[Klebsiella]], [[S. aureus]]
#3rd generation [[cephalosporin]] AND [[azithromycin]] OR [[doxycycline]]
*[[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====
====Health Care-associated PNA====

Revision as of 14:49, 21 April 2015

Outpatient, community-acquired PNA

Coverage targeted at S. pneumoniae, H. influenzae. M. pneumoniae, C. pneumoniae, and Legionella

Healthy

Unhealthy

Chronic heart, lung, liver, or renal disease; DM, alcholism, malignancy.


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


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
  1. ↑ 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
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