Template:Pneumonia Antibiotics

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

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