Pneumonia: antibiotic therapy recommendations

Infection

Pneumonia
Duration of treatment: Community acquired-mild: 7-10days. // Gram negative (usually nosocomial): 3 to 6 weeks. // Staphylococcal: 3 to 4 weeks // Legionella, mycoplasma, chlamydia: 14 to 21 days. // Lung abscess: 4 to 6 weeks.

Possible therapeutic alternatives

Pneumonia: Community acquired. (outpatient therapy) Adult 18-60yo

Common pathogens

Erythromycin 500mg orally four times daily or

Azithromycin 250 to 500mg orally once daily for 7-10 days or

Clarithromycin 500mg orally twice daily or 1gram (XR) orally once daily.

Doxycycline 100mg orally twice daily or

Levofloxacin 500 mg - 750 mg once daily or

Augmentin 875 mg orally twice daily or

moxifloxacin 400mg po qd x 10days

Community acquired. Adult (any age)

Common pathogens

Hospitalized patient:

*Erythromycin 500mg to 1 gram IV every 6 hours + Cefuroxime 750 mg IV every 8 hours (may substitute Azithromycin 500mg IV once daily for erythromycin) or

*Erythromycin 500mg to 1 gram IV every 6 hours + [Ceftriaxone 1 gram IV q12h or Cefotaxime 2 grams IV every 4 to 8 hours] or

If mild (monotherapy):

Azithromycin 500mg IV once daily x 2-5 days, then 500mg orally once daily or

Levofloxacin 500 - 750 mg IV/PO once daily.

Outpatient therapy:

Azithromycin 500mg once daily or

Clarithromycin 500mg twice daily or

Levofloxacin 500mg once daily or

Augmentin 875mg orally twice daily

Hospital acquired (nosocomial)

Common pathogens

[Piperacillin 3-4 grams IV every 6 hours + tobramycin] or

[Ceftazidime 1-2 grams IV every 8 hours or Cefepime 1-2 grams q 12h ] + tobramycin or

Ticarcillin-clavulanic acid 3.1g IV every 6 hours + Tobra/gent or

Imipenem 500mg IV every 6 hours.

Special considerations:

Add Erythromycin 500mg to 1 gram IV every 6 hours or Azithromycin 500mg IV once daily if legionella suspected.

Substitute: Aztreonam for piperacillin, timentin or cephalosporin if allergic to penicillin.

[Severe penicillin allergy]:
Levofloxacin 500mg IV qd + aminoglycoside or
Aztreonam + Aminoglycoside

Aspiration pneumonia

Common pathogens

Community acquired:

Clindamycin 600mg ivpb every 6 to 8 hours or

Augmentin 875mg PO bid or 500mg tid x 10 days

Hospital acquired:

Piperacillin-tazobactam 3.375g ivpb q6h or

Ticarcillin-clavulanic acid 3.1g ivpb q6h or

Ampicillin-sulbactam (Unasyn) 1.5-3.0 grams ivpb q6h.

Cefoxitin 2 grams ivpb q6-8h or Cefotetan 1-2 grams IV q12h.

[Cefotaxime 2g ivpb q8h or Ceftriaxone 2 grams ivpb q24h] + Clindamycin 600mg IV q6-8h.

Clindamycin 600mg IV q6-8h + [Ciprofloxacin 400mg IV q12h or Levofloxacin 500mg IV qd. ]

Hospital acquired: (Cover most common pathogens + possibility of aspiration)

Common pathogens

Piperacillin-tazobactam 3.375 grams IV every 6 hours + Ciprofloxacin 400mg IV q12h or

Cefepime 2 grams IV every 12 hours + Clindamycin 600mg IV every 6 hours.

(Elderly, nursing home, other risk factors, pseudomonas not suspected) OR Non-ICU patient:

Common pathogens

[Ceftriaxone 1-2 grams q12-24h or Cefepime 1-2 grams q12h] + Azithromycin 500mg IV qd.
Or
Levofloxacin 500mg IV qd.
Or
Moxifloxacin 400mg IV qd.

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References - Infectious Disease Section

Infectious Disease References

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The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.
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Infection

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