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Pneumonia - Community Acquired

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 patient Common pathogens
OUTPATIENT
No co-morbidities:
Azithromycin 500 mg x1, then 250 mg once daily OR   azithromycin 2 gm (XR) x 1 dose   (OR)
Clarithromycin 500mg orally twice daily or 1gram (XR) orally once daily x 7 days   (OR)
Doxycycline 100mg orally twice daily
Co-morbidities present:
Levofloxacin 750 mg once daily x 5 days (OR)
moxifloxacin 400mg po qd x 7-10days (OR)
Azithromycin 500 mg x1, then 250 mg once daily PLUS  [ Augmentin XR* 1000/62.5 mg 2 tablets orally twice daily or  Cefdinir 300 mg orally twice daily or Cefpodoxime 200 mg orally twice daily or
Cefprozil 500 mg orally twice daily] x  7 days

*AUGMENTIN XR is contraindicated in patients with a creatinine clearance of < 30 mL/min. and in hemodialysis patients
Community acquired PNEUMONIA -  Adult (any age) Common pathogens
Hospitalized patient:
Azithromycin 500mg  IV once daily PLUS Ceftriaxone 1 gram q24h   (OR)

Azithromycin 500mg  IV once daily PLUS
Ertapenem 1 gram q24h   (OR)

Monotherapy:
Levofloxacin 750 mg IV/PO once daily (OR)
Moxifloxacin 400mg IV qd.
ICU patient (CAP):
[Ceftriaxone 1-2 grams IV q24h  OR
Ampicillin-sulbactam (Unasyn) 1.5-3.0 grams ivpb q6h]

PLUS
 
[
Azithromycin 500mg  IV once daily OR Levofloxacin 750 mg IV/PO once daily (OR)
Moxifloxacin 400mg IV qd.]

PLUS
Vancomycin
- (patient-specific regimen - trough goal 15-20 mcg/ml)

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References - Infectious Disease Section

Infectious Disease References

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