Template:Pneumonia Antibiotics: Difference between revisions
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====Health Care-associated PNA==== | ====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==== | ====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==== | ====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]] | |||
Revision as of 05:57, 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