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Empiric therapy for bacterial community-acquired
pneumonia (CAP) in adults – IDSA 2004 -
hEPI40208
|
COMMUNITY SETTING - HISTORY |
Hx EXPOSURE |
TREATMENT |
ALTERNATIVE PO TREATMENT |
|
Healthy Community |
None |
Clarithromycin (Biaxin 500 mg po bid) |
Erythromycin, azithromycin, or clarithromycin. |
|
|
ATB |
Levofloxacin (Levaquin 500-750 mg po qd) |
Clarithro PLUS Amox 1gr po tid;
OR
Clarithro Plus Amox 2gr po bid /Clavul |
|
Hx Dbt, Kidney, Heart, Pulm, CA |
None |
Clarithromycin (Biaxin 500 mg po bid) |
Levofloxacin (Levaquin 500-750 mg po/IV qd) |
|
|
ATB |
Levofloxacin (Levaquin 500-750 mg po qd) |
Clarithro PLUS Amoxi 1grTID (CefUroxime-Ceftin 500 po qid ; Cefpodoxime, cefroxil 500 q6 |
|
Aspiration |
--- |
Amoxicillin (Amoxil 1gr po tid) |
Clindamycin (Cleocin 300-600 mg po/IV qid) |
|
Influenza |
--- |
Amoxicillin /Clavulnate (Augmentin 2gr po bid) |
Levofloxacin (Levaquin 500-750 mg po qd) |
|
nOSOCOMIAL SETTinG - HISTORY |
Hx EXPOSURE |
TREATMENT |
ALTERNATIVE TREATMENT |
|
Medical ward |
None |
Levofloxacin (Levaquin 500-750 mg po qd) |
Clarithro PLUS Cefotaxime (ceftriaxone, ampicillin-sulbactam, or ertapenem; ertapenem) |
|
|
ATB |
Clarithro PLUS Cefotaxime (ceftriaxone, ampicillin-sulbactam, or ertapenem; ertapenem) |
Levofloxacin (Levaquin 500-750 mg po qd) |
|
ICU |
None |
Clarithro PLUS Cefotaxime (ceftriaxone, ampicillin-sulbactam, or ertapenem; ertapenem) |
Levofloxacin (Levaquin 500-750 mg po qd) PLUS Cefotaxime (ceftriaxone,
ampicillin-sulbactam, or ertapenem; ertapenem) |
|
Allergic to -lactam |
None |
Levofloxacin (Levaquin 500-750 mg po qd) PLUS Clinda |
|
|
History of Bronchiectasis, antibiotic treatment, stay in hospital, stay in the ICU. Assure coverage for
S. pneumoniae and Legionella. Consider antipseudomonal agents when there is concern about gram-negative bacteria. |
PAerog |
Piperacillin-tazobactam (Zosyn 3.375 gm iv qid) (imipenem-Premaxin 500 iv
qid), meropenem, or cefepime) PLUS Levo |
Piperacillin-tazobactam (imipenem, meropenem, and cefepime)
PLUS Azithro (Or Aminoglicoside -elderly patients receiving aminoglycosides have worse outcomes-) |
|
Allergic to -lactam |
PAerog |
Aztreonam 750 mg q.d. PLUS Levofloxacin |
Aztreonam 750 mg q.d. PLUS Moxifloxacin (gatifloxacin)
, with or without an aminoglycoside |
|
|
|
|
|
Nursing home Patient |
|
Levofloxacin (Levaquin 500-750 mg po qd)
|
Clarithro Plus Amox 2gr po bid /Clavul |
Commercial
names included for reference only. Generic drugs can be switched by other antibiotics from the same family. Risk factors
for Pseudomonas infection are history of severe structural
lung disease, recent antibiotic therapy, stay in ICU. Always
assure coverage for S. pneumoniae and Legionella species for patients with CAP in
the ICU. Consider antipseudomonal agents when there is concern
for relatively unusual pathogens, such as Pseudomonas aeruginosa, Klebsiella species, and other
gram-negative bacteria. Duration of therapies are as follows: S. pneumoniae, until afebrile for 3 d. (C-III); C. pneumoniae, has good clinical response with 7 14 days of treatment (A-I); Legionella,
10 21 days (B-II); pathogens that potentially
cause pulmonary necrosis (S. aureus, P. aeruginosa, Klebsiella species, or anaerobes),
exceed 14 D. (B-II). CDC, Centers for Disease Control and Prevention. Vancin 1 gr iv bid. Reference:
Mandell , L,; Barttlet, J. Update of Practice Guidelines
for the Management of Community-Acquired Pneumonia in
Immunocompetent Adults, 2003.
Disclaimer: The material edited in this website is intended for information purposes only. Please refer to the references
provided for updated information regarding to the topic.
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