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 |
Community-acquired Pneumonia (CAP): (outpatient therapy) Adult patient
|
| 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) |
|
Hospital-acquired PNEUMONIA (HAP)
|
| Hospital-acquired PNEUMONIA (HAP) (nosocomial) |
Common pathogens |
| Multi-drug resistance unlikely |
Ceftriaxone 1-2 grams IV q24h OR
Ampicillin-sulbactam (Unasyn) 3.0 grams ivpb q6h OR
Levofloxacin 750 mg IV/PO once daily |
| Multi-drug resistance LIKELY |
Piperacillin-tazobactam 3.375g ivpb q6h OR
Cefepime 2 grams IV every 12 hours OR
Meropenem 1 gm IV q8h
PLUS (If MRSA suspected)
Vancomycin - (patient-specific regimen - trough goal 15-20 mcg/ml) |
|
Aspiration pneumonia
|
|
Common pathogens |
|
| Hospital acquired: (Cover most common pathogens + possibility of aspiration) |
Common pathogens |
|
Ventilator-associated pneumonia (VAP)
|
| (Mild to moderate infection AND multi-drug resistance unlikely): |
Common pathogens |
Ceftriaxone 1-2 grams IV q24h OR
Ampicillin-sulbactam (Unasyn) 3.0 grams ivpb q6h OR
Levofloxacin 750 mg IV/PO once daily OR
Ertapenem 1 gm IV q24h
PLUS (If MRSA suspected)
Vancomycin - (patient-specific regimen - trough goal 15-20 mcg/ml) |
|
| (Severe infection OR multi-drug resistance LIKELY): |
Common pathogens |
Cefepime 2 grams IV every 12 hours OR
Piperacillin-tazobactam 4.5 grams IV Q6H OR
Meropenem 1 gm IV q8h
PLUS
Vancomycin - (patient-specific regimen - trough goal 15-20 mcg/ml)
PLUS
Ciprofloxacin 400mg IV q8h OR
Levofloxacin 750 mg IV/PO once daily OR
Aminoglycoside (Tobra) - patient-specific regimen. |
|
