Template:Pneumonia Antibiotics: Difference between revisions
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==OUTPATIENT COMMUNITY-ACQUIRED PNEUMONIA== | |||
''Coverage targeted at [[S. pneumoniae]], [[H. influenzae]]. [[M. pneumoniae]], [[C. pneumoniae]], and [[Legionella]] | ''Coverage targeted at [[S. pneumoniae]], [[H. influenzae]]. [[M. pneumoniae]], [[C. pneumoniae]], and [[Legionella]] | ||
====Healthy==== | ====Healthy==== | ||
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**[[Clarithromycin]] 500mg PO BID x 7-10 days | **[[Clarithromycin]] 500mg PO BID x 7-10 days | ||
==INPATIENT PNEUMONIAS== | |||
*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> | ||
*The use of adjunctive corticosteroids (methylprednisolone 0.5 mg/kg IV BID x 5d) in CAP of moderate-high severity (PSI Score IV or V; [[CURB-65]] ≥ 2) is associated with:<ref>Siemieniuk RA, Meade MO, Alonso-Coello P, Briel M, Evaniew N, Prasad M, Alexander PE, Fei Y, Vandvik PO, Loeb M, Guyatt GH. Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia: A Systematic Review and Meta-analysis. Ann Intern Med. Aug 11, 2015</ref> | *The use of adjunctive corticosteroids (methylprednisolone 0.5 mg/kg IV BID x 5d) in CAP of moderate-high severity (PSI Score IV or V; [[CURB-65]] ≥ 2) is associated with:<ref>Siemieniuk RA, Meade MO, Alonso-Coello P, Briel M, Evaniew N, Prasad M, Alexander PE, Fei Y, Vandvik PO, Loeb M, Guyatt GH. Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia: A Systematic Review and Meta-analysis. Ann Intern Med. Aug 11, 2015</ref> | ||
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**[[Imipenem]] 500mg q6hr + [[cipro]] 400mg q8hr + [[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 | **[[Piperacillin-Tazobactam]] 4.5gm q6h + [[cipro]] 400mg q8h + [[vanco]] 15mg/kg q12 | ||
====Ventilator Associated Pneumnoia==== | |||
*High Risk of MRSA: Use 3-Drug Regimen. Several options are available, but recommendation is to include an antibiotic from each of these categories:<ref>Kalil AC, Metersky ML, Klompas M et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. [http://cid.oxfordjournals.org/content/early/2016/07/06/cid.ciw353.full.pdf Clin Infect Dis. 2016 Sep 1;63(5):e61-e111.]</ref> | |||
**1. ''MRSA Antibiotic:'' [[Vancomycin]] 15mg/kg q12h OR [[Linezolid]] 600 mg IV q12h '''PLUS''' | |||
**2. ''Antipseudomonal Antibiotic:'' [[Piperacillin-Tazobactam]] 4.5gm q6h OR [[Cefepime]] 2 g IV q8h OR [[Imipenem]] 500 mg IV q6h OR [[Aztreonam]] 2 g IV q8h '''PLUS''' | |||
**3. ''GN Antibiotic With Antipseudomonal Activity:'' [[Cipro]] 400 mg IV q8h | |||
====ICU, low risk of pseudomonas==== | ====ICU, low risk of pseudomonas==== | ||
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* [[Cefipime]], [[imipenem]], OR [[piperacillin-tazobactam]] + [[gent]] + [[azithromycin]] | * [[Cefipime]], [[imipenem]], OR [[piperacillin-tazobactam]] + [[gent]] + [[azithromycin]] | ||
* [[Cefipime]], [[imipenem]], OR [[piperacillin-tazobactam]] + [[gent]] + [[cipro]]/[[levo]] | * [[Cefipime]], [[imipenem]], OR [[piperacillin-tazobactam]] + [[gent]] + [[cipro]]/[[levo]] | ||
===References=== | |||
<references> | |||
Revision as of 19:19, 24 August 2016
OUTPATIENT COMMUNITY-ACQUIRED PNEUMONIA
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 PNEUMONIAS
- Monotherapy or combination therapy is acceptable. Combination therapy includes a cephalosporin and macrolide targeting atypicals and Strep Pneumonia [1]
- The use of adjunctive corticosteroids (methylprednisolone 0.5 mg/kg IV BID x 5d) in CAP of moderate-high severity (PSI Score IV or V; CURB-65 ≥ 2) is associated with:[2]
- ↓ mortality (3%)
- ↓ need for mechanical ventilation (5%)
- ↓ length of hospital stay (1d)
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
Hospital Acquired or Ventilator Associated Pneumonia
- 3-drug regimen recommended
- (Cefepime 1-2gm q8-12h OR ceftazidime 2gm q8h) + Levofloxacin 750 mg PO/IV every 24 hours + Vancomycin 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
Ventilator Associated Pneumnoia
- High Risk of MRSA: Use 3-Drug Regimen. Several options are available, but recommendation is to include an antibiotic from each of these categories:[3]
- 1. MRSA Antibiotic: Vancomycin 15mg/kg q12h OR Linezolid 600 mg IV q12h PLUS
- 2. Antipseudomonal Antibiotic: Piperacillin-Tazobactam 4.5gm q6h OR Cefepime 2 g IV q8h OR Imipenem 500 mg IV q6h OR Aztreonam 2 g IV q8h PLUS
- 3. GN Antibiotic With Antipseudomonal Activity: Cipro 400 mg IV q8h
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
References
<references>
- ↑ 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
- ↑ Siemieniuk RA, Meade MO, Alonso-Coello P, Briel M, Evaniew N, Prasad M, Alexander PE, Fei Y, Vandvik PO, Loeb M, Guyatt GH. Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia: A Systematic Review and Meta-analysis. Ann Intern Med. Aug 11, 2015
- ↑ Kalil AC, Metersky ML, Klompas M et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016 Sep 1;63(5):e61-e111.