Sandbox ID Lower Respiratory Tract: Difference between revisions

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===Pneumonia, community-acquired===
===Pneumonia, community-acquired===
* '''Community acquired pneumonia'''
* '''Community acquired pneumonia'''
:* Empiric therapy
:*''' Empiric therapy in adults'''
::* Adult; Outpatient treatment
::* (A) Outpatient treatment
::*(1) Previously healthy and no use of antimicrobials within the previous 3 months.
:::*(1) Previously healthy and no use of antimicrobials within the previous 3 months.
:::* Preferred regimen : [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 {{or}} [[Azithromycin]] 500 mg IV as a single dose {{or}} [[Clarithromycin]] 250 mg q12h for 7-14 days {{or}} 1000 mg q24h for 7 days {{or}} [[Erythromycin]] 250-500 mg q6-12h (max: 4 g/day)
::::* Preferred regimen : [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 {{or}} [[Azithromycin]] 500 mg IV as a single dose {{or}} [[Clarithromycin]] 250 mg q12h for 7-14 days {{or}} 1000 mg q24h for 7 days {{or}} [[Erythromycin]] 250-500 mg q6-12h (max: 4 g/day)
:::* Alternative regimen : [[Doxycycline]] 100 mg PO/IV q12h (Weak recommendation).
::::* Alternative regimen : [[Doxycycline]] 100 mg PO/IV q12h (Weak recommendation).
:::*(2) Presence of comorbidities such as chronic heart, lung, liver or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressing conditions or use of immunosuppressing drugs; or use of antimicrobials within the previous 3 months (in this case an alternative from a different class should be selected)
::::* Preferred regimen (1) :  [[Levofloxacin]] 500 mg q24h for 7-14 days or 750 mg q24h for 5 days {{or}} [[Moxifloxacin]] 400 mg PO/IV q24h for 7-14 days {{or}}  [[Gemifloxacin]] 320 mg PO q24h for 5 or 7 days
::::* Preferred Regimen (2) : [[Amoxicillin]] 875 mg PO q12h or 500 mg q8h {{or}} [[Amoxicillin-clavulanate]] 2 g q12h {{or}} [[Ceftriaxone]] 1 g IV q24h, (2 g q24h for patients at risk) {{or}} [[Cefpodoxime]] 200 mg PO q12h for 14 days {{or}} [[Cefuroxime]] 750 mg IM/IV q8h {{and}} Macrolide {{or}} [[Doxycycline]] 100 mg PO/IV q12h


::*(2) Presence of comorbidities such as chronic heart, lung, liver or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressing conditions or use of immunosuppressing drugs; or use of antimicrobials within the previous 3 months (in which case an alternative from a different class should be selected)
::* (B) Inpatient Therapy (in regions with a high rate (125%) of infection with high-level (MIC 16 mg/mL) macrolide-resistant Streptococcus pneumoniae)
:::* Preferred regimen (1) : [[Levofloxacin]] 500 mg q24h for 7-14 days or 750 mg q24h for 5 days {{or}} [[Moxifloxacin]] 400 mg PO/IV q24h for 7-14 days {{or}} [[Gemifloxacin]] 320 mg PO q24h for 5 or 7 days
:::* (1) Non-ICU treatment
:::* Preferred Regimen (2) : [[Amoxicillin]] 875 mg PO q12h or 500 mg q8h {{or}} [[Amoxicillin-clavulanate]] 2 g q12h {{or}} [[Ceftriaxone]] 1 g IV q24h, (2 g q24h for patients at risk) {{or}} [[Cefpodoxime]] 200 mg PO q12h for 14 days {{or}} [[Cefuroxime]] 750 mg IM/IV q8h {{and}} Macrolide {{or}} [[Doxycycline]] 100 mg PO/IV q12h
::::* Preferred Regimen : [[Levofloxacin]] 500 mg q24h for 7-14 days or 750 mg q24h for 5 days {{or}} [[Moxifloxacin]] 400 mg PO/IV q24h for 7-14 days {{or}} [[Gemifloxacin]] 320 mg PO q24h for 5 or 7 days {{or}} [[Amoxicillin ]]1 g q8h {{or}} [[Amoxicillin-clavulanate]] 2 g q12h
::::* Alternative Regimen : [[Ceftriaxone]] 1 g IV q24h, (2 g q24h for patients at risk) {{or}} [[Cefpodoxime]] 200 mg PO q12h for 14 days {{or}} [[Cefuroxime]] 750 mg IM/IV q8h
:::* (2) ICU
::::* Preferred Regimen : [[Cefotaxime]] I.M., I.V.: 1 g q12h {{or}} [[Ceftriaxone]] 1 g IV q24h, 2 g/day for patients at risk {{or}} [[Ampicillin-sulbactam]] 1.5-3 g IV q6h {{and}} [[Azithromycin]] 500 mg/day PO once, followed by 250 mg q24h for 4 days {{or}} [[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}}[Levofloxacin ]]500 mg q24h for 7-14 days or 750 mg q24h for 5 days {{or}} [[Moxifloxacin]] 400 mg PO/IV q24h for 7-14 days {{or}} [[Gemifloxacin]] Oral: 320 mg q24h for 5 or 7 days
::::* Alternative Regimen (For penicillin allergy): [[Levofloxacin]] 500 mg q24h for 7-14 days or 750 mg q24h for 5 day {{or}} [[Moxifloxacin 400 mg q24h PO/IV for 7-14 days {{or}} [[Gemifloxacin]] 320 mg PO q24h for 5 or 7 days {{and}} [[Aztreonam]] I.V.: 2 g q6-8h (max: 8 g/day)


::*(3) In regions with a high rate (125%) of infection with high-level (MIC 16 mg/mL) macrolide-resistant Streptococcus pneumoniae,
::* (C) Special Concerns
:::*Inpatients, non-ICU treatment
:::* (1) Pseudomonas
:::*Preferred Regimen : [[Levofloxacin]] 500 mg q24h for 7-14 days or 750 mg q24h for 5 days {{or}} [[Moxifloxacin]] 400 mg PO/IV q24h for 7-14 days {{or}} [[Gemifloxacin]] 320 mg PO q24h for 5 or 7 days {{or}} [[Amoxicillin ]]1 g q8h {{or}} [[Amoxicillin-clavulanate]] 2 g q12h
::::* Preferred Regimen (1): [[Piperacillin-tazobactam]] 3.375 g IV q6h for 7-10 days {{or}} [[Cefepime]] 1-2 g q12h for 10 days {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 500 mg IV q8h {{and}} [[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}} [[Levofloxacin]] 500 mg q24h for 7-14 days or 750 mg q24h for 5 day
:::* Alternative Regimen : [[Ceftriaxone]] 1 g IV q24h, (2 g q24h for patients at risk) {{or}} [[Cefpodoxime]] 200 mg PO q12h for 14 days {{or}} [[Cefuroxime]] 750 mg IM/IV q8h
::::* Preferred Regimen (2): [[Piperacillin-tazobactam]] 3.375 g IV q6h for 7-10 days {{or}} [[Cefepime]] 1-2 g q12h for 10 days {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 500 mg IV q8h {{and}} Aminoglycoside {{and}} [[Azithromycin]] Oral: 500 mg on day 1 followed by 250 mg q24h on days 2-5 {{or}} [[Levofloxacin]] 500 mg q24h for 7-14 days or 750 mg q24h for 5 days {{or}} [[Moxifloxacin]] 400 mg PO/IV q24h for 7-14 days {{or}} [[Gemifloxacin]] 320 mg PO q24h for 5 or 7 days
:::: Note : For penicillin-allergic patients, substitute the B-lactam for Aztreonam 2 g IV q6-8h (max 8 g/day)
:::* (2) Methicillin resistant staphylococcus aureus ,Add the following to the selected regimen
::::* Preferred regimen: [[Vancomycin]] 45-60 mg/kg/day divided q8-12h {{or}} [[Linezolid]] 600 mg PO/IV q12h for 10-14 days.


::*Adult Inpatient Therapy, ICU
:*''' Empiric therapy in neonates''' ( Age < 1 month)
:::* Preferred Regimen : [[Cefotaxime]] I.M., I.V.: 1 g q12h {{or}} [[Ceftriaxone]] 1 g IV q24h, 2 g/day for patients at risk {{or}} [[Ampicillin-sulbactam]] 1.5-3 g IV q6h {{and}} [[Azithromycin]] 500 mg/day PO once, followed by 250 mg q24h for 4 days {{or}} [[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}}[Levofloxacin ]]500 mg q24h for 7-14 days or 750 mg q24h for 5 days {{or}} [[Moxifloxacin]] 400 mg PO/IV q24h for 7-14 days {{or}} [[Gemifloxacin]] Oral: 320 mg q24h for 5 or 7 days
::* Preferred regimen: [[Ampicillin]] 500 mg/day for 7-14 days or 750 mg/day for 5 days {{or}} [[Gentamicin]] 400 mg/day PO/IV for 7-14 days With or without [[Cefotaxime]] 320 mg PO q24h for 5 or 7 days
:::*Alternative Regimen (For penicillin allergy): [[Levofloxacin]] 500 mg q24h for 7-14 days or 750 mg q24h for 5 day {{or}} [[Moxifloxacin 400 mg q24h PO/IV for 7-14 days {{or}} [[Gemifloxacin]] 320 mg PO q24h for 5 or 7 days {{and}} [[Aztreonam]] I.V.: 2 g q6-8h (max: 8 g/day)
::: Note (1) : If methicillin resistant staphylococcus aureus  is suspected, add the following [[Vancomycin]] 10 mg/kg q8h
::: Note (2) : If Chlamydia trachomatis is suspected, add the following [[Erythromycin]] 12.5 mg/kg PO or IV qid x 14 days {{or}} [[Azithromycin]] 10 mg/kg PO/IV on day one then 5 mg/kg PO/IV q24h for 4 days.
::* Alternate Regimen (If methicillin resistant staphylococcus aureus  is suspected): [[Vancomycin]] 10 mg/kg q8h {{or}} [[Linezolid]] 10 mg/kg q8h


::*Adult Special Concerns - Pseudomonas
:*'''Empiric therapy,Children (> 3 months) Outpatient Therapy'''
:::*Preferred Regimen (1): [[Piperacillin-tazobactam]] 3.375 g IV q6h for 7-10 days {{or}} [[Cefepime]] 1-2 g q12h for 10 days {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 500 mg IV q8h {{and}} [[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}} [[Levofloxacin]] 500 mg q24h for 7-14 days or 750 mg q24h for 5 day
::* Preferred Regimen: [[Amoxicillin]] 90 mg/kg/day q12h for 5 days {{or}} [[Azithromycin]] 10 mg/kg PO 1 dose (max 500 mg), then 5 mg/kg (max 250 mg) PO for 4 days
::*Preferred Regimen (2): [[Piperacillin-tazobactam]] 3.375 g IV q6h for 7-10 days {{or}} [[Cefepime]] 1-2 g q12h for 10 days {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 500 mg IV q8h {{or}} {{add}} Aminoglycoside {{add}} [[Azithromycin]] Oral: 500 mg on day 1 followed by 250 mg q24h on days 2-5 {{or}} [[Levofloxacin]] 500 mg q24h for 7-14 days or 750 mg q24h for 5 days {{or}} [[Moxifloxacin]] 400 mg PO/IV q24h for 7-14 days {{or}} [[Gemifloxacin]] 320 mg PO q24h for 5 or 7 days
::* Alternate Regimen: [[Amoxicillin-clavulanate]] 90 mg/kg/day {{or}} [[Clarithromycin]] 15 mg/kg/day q12h for 7-14 days


*For penicillin-allergic patients, substitute the B-lactam for Aztreonam 2 g IV q6-8h (max 8 g/day)
:*'''pathogen specific regimen (bacteria)'''
::* Adult Special Concerns : - methicillin resistent staphylococcus aureus ,Add the following to the selected regimen
::* (A) Streptococcus pneumoniae
:::* Preferred regimen: [[Vancomycin]] 45-60 mg/kg/day divided q8-12h {{or}} [[Linezolid]] 600 mg PO/IV q12h for 10-14 days.
:::* (1) Penicillin nonresistant; MIC < 2 mg / mL
::::* Preferred Regimen : [[Penicillin G]] 2-3 million units IV q4h {{or}} [[Amoxicillin]] 875 mg PO q12h or 500 mg q8h
::::* Alternative Regimen : [[Macrolide]] {{or}} [[Cefpodoxime]] 200 mg PO q12h for 14 days {{or}} [[Cefprozil]] 500 mg PO q12h for 10 days {{or}} [[Cefuroxime]] 750 mg PO/IV q8h {{or}} [[Cefdinir]] 300 mg PO q12h for 10 days {{or}} [[Cefditoren]] 400 mg PO q12h for 14 day {{or}} [[Ceftriaxone]] 1 g IV q24h, 2 g daily for patients at risk {{or}} [[Cefotaxime]] 1 g IM/IV q12h {{or}} [[Clindamycin]] 150-450 mg PO q6-8h (max: 1800 mg/day) {{or}} [[Clindamycin]] 1.2-2.7 g/day IM/IV in 2-4 divided doses (max:4800 mg/day) {{or}} [[Doxycycline]] 100 mg PI/IV q12h {{or}} Respiratory [[fluoroquinolone]]
:::* (2) Penicillin resistant; MIC > 2 mg / mL
::::* Preferred Regimen (Agents chosen on the basis of susceptibililty) : [[Cefotaxime]] 1 g IM/IV q12h {{or}} [[Ceftriaxone]] 1 g IV q24h, 2 g daily for patients at risk {{or}} [[Fluoroquinolone]]
::::* Alternative Regimen: [[Vancomycin]] 45-60 mg/kg/day divided q8-12h (max: 2000 mg/dose) for 7-21 days depending on severity {{or}} [[Linezolid]] 600 mg PO/IV q12h for 10-14 days {{or}} [[Amoxicillin]] 875 mg PO q12h or 500 mg q8 ( 3 g/day with penicillin MIC 4 ≤ microgram / mL)
 
::* (B)Haemophilus influenzae
:::* (1) Non–B-lactamase producing
::::* Preferred Regimen: [[Amoxicillin]] 875 mg PO q12h or 500 mg q8h
::::* Alternative Regimen : [[Fluoroquinolone]] {{or}} [[Doxycycline]] 100 mg PO/IV q12h {{or}} [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 {{or}} [[Clarithromycin]] 250 mg q12h for 7-14 days or 1000 mg q24h for 7 days
:::* (2) B-lactamase producing
::::* Preferred Regimen: 2nd or 3rd Generation [[Cephalosporin]] {{or}} [[Amoxicillin-clavulanate]] 2 g q12h
::::* Alternative Regimen: [[Fluoroquinolone]] {{or}} [[Doxycycline]] 100 mg PO/IV q12h {{or}} [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 {{or}} [[Clarithromycin]] 250 mg q12h for 7-14 days or 1000 mg q24h for 7 days
 
::* (C) Bacillus anthracis (inhalation)
:::* Preferred Regimen  :[[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}} [[Levofloxacin]] 500 mg q24h for 7-14 days or 750 mg q24h for 5 days {{or}} [[Doxycycline]] 100 mg PO/IV q12h
:::* Alternate Regimen : Other [[fluoroquinolones]] {{or}} B-lactam (if susceptible) {{or}} [[Rifampin]] 600 mg PO/IV q24h for 4 days {{or}} [[Clindamycin]] 150-450 mg PO q6-8h {{or}} [[Chloramphenicol]] 50-100 mg/kg/day IV in divided q6h
 
::* (D) Enterobacteriaceae
:::* Preferred Regimen: 3rd generation cephalosporin {{or}} [[Carbapenem]] (†) (drug of choice if extended-spectrum b-lactamase producer)
:::* Alternate Regimen : b-Lactam / b-lactamase inhibitor (‡) {{or}} [[Fluoroquinolone]] (†)= [[Imipenem]]-[[cilastatin]], [[meropenem]], [[ertapenem]] (‡)= Piperacillin-tazobactam for gram-negative bacilli, [[ticarcillin-clavulanate]], [[ampicillin-sulbactam]] or [[amoxicillin-clavulanate]]
 
::* (E)Pseudomonas aeruginosa
:::* Preferred Regimen: [[Ticarcillin]] 200-300 mg/kg/day in divided doses q4-6h (max: 18 g/day) {{or}} [[Piperacillin]] 6-8 g/day IM/IV (100-125 mg/kg daily) divided q6-12h {{or}} [[Ceftazidime]] 500 mg to 1 g q8h {{or}} [[Cefepime]] 1-2 g q12h for 10 days {{or}} [[Aztreonam]] 2 g IV q6-8h (max: 8 g/day {{or}}[[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 500 mg IV q8h {{and}} [[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}} [[Levofloxacin]] 750 mg daily {{or}} [[Aminoglycoside]]
:::* Alternate Regimen: [[Aminoglycoside]] {{and}} [[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}} [[Levofloxacin]] 750 mg daily
 
::* (F)Staphylococcus aureus
:::* (1) Methicillin susceptible
::::* Preferred Regimen : [[Nafcillin]] 1000-2000 mg q4h {{or}} [[Oxacillin]] 2 g IV q4h {{or}} [[Flucloxacillin]] 250 mg IM/IV q6h
::::* Alternative Regimen : [[Cefazolin]] 500 mg IV q12h {{or}} [[Clindamycin]] 150-450 mg PO q6-8h
:::* (2) Methicillin resistant
::::* Preferred Regimen : [[Vancomycin]] 45-60 mg/kg/day divided q8-12h (max: 2000 mg/dose) for 7-21 days {{or}} [[Linezolid]] 600 mg PO/IV q12h for 10-14 days
::::* Alternative Regimen: TMP-SMX 1-2 double-strength tablets (800/160 mg) q12-24h
 
::* (G)Bordetella pertussis
:::* Preferred Regimen: [[Macrolide]]
:::* Alternate Regimen: [[TMP-SMX]] 1-2 double-strength tablets (800/160 mg) q12-24h
 
::* (H) Anaerobe (aspiration)
:::* Preferred Regimen: [[Piperacillin-tazobactam]] 3.375 g IV q6h for 7-10 days (For gram-negative bacilli) {{or}} [[Ticarcillin clavulanate]] 200-300 mg/kg/day IV divided q4-6h (max: 18 g/day) {{or}} [[Ampicillin-sulbactam]] 1500-3000 mg IV q6h {{or}} [[Amoxicillin-clavulanate]] 250-500 mg PO q8h or 875 mg q12h {{or}} [[Clindamycin]] 150-450 mg PO q6-8h (max: 1800 mg/day)
:::* Alternate Regimen: [[Carbapenem]]
 
::* (I) Mycobacterium tuberculosis
:::* Preferred Regimen: [[Isoniazid]] 5 mg/kg/day q24h (usual dose: 300 mg/day) {{and}} [[Rifampin]] 10 mg/kg/day (maximum: 600 mg / day) {{and}} [[Ethambutol]] 5-25 mg/kg (maximum dose: 1.6 g) {{and}} [[Pyrazinamide]] 1000 - 2000 mg / day
:::* Alternate Regimen: Click here for more treatment regimens
::* (J) Yersinisa pestis
:::* Preferred Regimen: [[Streptomycin]] 15 mg/kg/day (max 1 g/day) {{or}} [[Gentamicin]] 7 mg/kg/day
:::* Alternate Regimen: [[Doxycycline]] 100 mg PO/IV q12h {{or}} [[Fluoroquinolone]]
 
:*'''pathogen specific regimen (atypical bacteria)'''
::* (A) Mycoplasma pneumoniae
:::* Preferred Regimen: [[Macrolide]] {{or}} [[Tetracycline]] Oral: 250-500 mg q6h
:::* Alternate Regimen: [[Fluoroquinolone]]
 
::* (B) Chlamydophila pneumoniae
:::* Preferred Regimen: [[Macrolide]] {{or}} [[Tetracycline]] 250-500 mg PO q6h
:::* Alternate Regimen: [[Fluoroquinolone]]
 
::* (C) Legionella species
:::* Preferred Regimen: [[Fluoroquinolone]] {{or}} [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h
:::* Alternate Regimen: [[Doxycycline]] 100 mg PO/IV q12h
 
::* (D)Chlamydophila psittaci
:::* Preferred Regimen: [[Tetracycline]] 250-500 mg PO q6h
:::* Alternate Regimen: [[Macrolide]]
 
::* (E) Coxiella burnetii
:::* Preferred Regimen: [[Tetracycline]] 250-500 mg PO q6h
:::* Alternate Regimen: [[Macrolide]]
 
::* (F) Francisella tularensis
:::* Preferred Regimen: [[Doxycycline]]
:::* Alternate Regimen: [[Gentamicin]] 7 mg/kg/day {{or}} [[Streptomycin]] 15 mg/kg/day (maximum: 1 g)
 
::* (G) Burkholderia pseudomallei
:::* Preferred Regimen : [[Carbapenem]] {{or}} [[Ceftazidime]] 0.5-1 g q8h
:::* Alternate Regimen: [[Fluoroquinolone]] {{or}} [[TMP-SMX]] 1-2 double-strength tablets (800/160 mg) q12-24h
 
::* (H) Acinetobacter species
:::* Preferred Regimen : [[Carbapenem]]
:::* Alternate Regimen: [[Cephalosporin]]-[[aminoglycoside]]  {{or}} [[Ampicillin-sulbactam]] {{or}} [[Colistin]] 2.5-5 mg/kg/day IM/IV divided q6-12h (max: 5 mg/kg/day)
 
:*'''pathogen specific regimen (viral)'''
::* Influenza virus
:::* Preferred Regimen: [[Oseltamivir]] 75 mg PO q12h for 5 days (initiated within 48 hours of onset of symptoms) {{or}} [[Zanamivir]] Two inhalations (10 mg total) q12h for 5 days (Doses on first day should be separated by at least 2 hours; on subsequent days, doses should be spaced by ~12 hours)
 
:*'''pathogen specific regimen (fungal)'''
::* (A) Coccidioides species
:::* Preferred Regimen: [[Itraconazole]] 200 mg q12h {{or}} [[Fluconazole]] 200-400 mg daily for 3-6 month
:::* Alternate Regimen: [[Amphotericin]] B 0.5-0.7 mg/kg/day
::::Note: No therapy is indicated for uncomplicated infection, treat only if complicated infection
 
::* (B) Histoplasmosis
:::* Preferred Regimen: [[Itraconazole]] 200 mg q12h
:::* Alternate Regimen: [[Amphotericin]] B 0.5-0.7 mg/kg/day
 
::* (C) Blastomycosis
:::* Preferred Regimen: [[Itraconazole]] 200 mg q12h
:::* Alternate Regimen: [[Amphotericin]] B 0.5-0.7 mg/kg/day


===Pneumonia, concomitant influenza===
===Pneumonia, concomitant influenza===

Revision as of 15:10, 10 June 2015

Acute bacterial exacerbations of chronic bronchitis

Bronchiectasis

Bronchiolitis

Bronchitis

Cystic fibrosis

Empyema

Influenza

Inhalational anthrax, Prophylaxis

Inhalational anthrax, Treatment

Pertussis

Pneumonia, Acinetobacter

Pneumonia, Actinomycosis

Pneumonia, Anaerobes

Pneumonia, Aspiration pneumonia

Pneumonia, Chlamydophila

Pneumonia, community-acquired

  • Community acquired pneumonia
  • Empiric therapy in adults
  • (A) Outpatient treatment
  • (1) Previously healthy and no use of antimicrobials within the previous 3 months.
  • Preferred regimen : Azithromycin 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 OR Azithromycin 500 mg IV as a single dose OR Clarithromycin 250 mg q12h for 7-14 days OR 1000 mg q24h for 7 days OR Erythromycin 250-500 mg q6-12h (max: 4 g/day)
  • Alternative regimen : Doxycycline 100 mg PO/IV q12h (Weak recommendation).
  • (2) Presence of comorbidities such as chronic heart, lung, liver or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressing conditions or use of immunosuppressing drugs; or use of antimicrobials within the previous 3 months (in this case an alternative from a different class should be selected)
  • (B) Inpatient Therapy (in regions with a high rate (125%) of infection with high-level (MIC 16 mg/mL) macrolide-resistant Streptococcus pneumoniae)
  • (1) Non-ICU treatment
  • (2) ICU
  • Preferred Regimen : Cefotaxime I.M., I.V.: 1 g q12h OR Ceftriaxone 1 g IV q24h, 2 g/day for patients at risk OR Ampicillin-sulbactam 1.5-3 g IV q6h AND Azithromycin 500 mg/day PO once, followed by 250 mg q24h for 4 days OR Ciprofloxacin 500-750 mg q12h for 7-14 days OR[Levofloxacin ]]500 mg q24h for 7-14 days or 750 mg q24h for 5 days OR Moxifloxacin 400 mg PO/IV q24h for 7-14 days OR Gemifloxacin Oral: 320 mg q24h for 5 or 7 days
  • Alternative Regimen (For penicillin allergy): Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 day OR [[Moxifloxacin 400 mg q24h PO/IV for 7-14 days OR Gemifloxacin 320 mg PO q24h for 5 or 7 days AND Aztreonam I.V.: 2 g q6-8h (max: 8 g/day)
  • (C) Special Concerns
  • (1) Pseudomonas
Note : For penicillin-allergic patients, substitute the B-lactam for Aztreonam 2 g IV q6-8h (max 8 g/day)
  • (2) Methicillin resistant staphylococcus aureus ,Add the following to the selected regimen
  • Preferred regimen: Vancomycin 45-60 mg/kg/day divided q8-12h OR Linezolid 600 mg PO/IV q12h for 10-14 days.
  • Empiric therapy in neonates ( Age < 1 month)
  • Preferred regimen: Ampicillin 500 mg/day for 7-14 days or 750 mg/day for 5 days OR Gentamicin 400 mg/day PO/IV for 7-14 days With or without Cefotaxime 320 mg PO q24h for 5 or 7 days
Note (1) : If methicillin resistant staphylococcus aureus is suspected, add the following Vancomycin 10 mg/kg q8h
Note (2) : If Chlamydia trachomatis is suspected, add the following Erythromycin 12.5 mg/kg PO or IV qid x 14 days OR Azithromycin 10 mg/kg PO/IV on day one then 5 mg/kg PO/IV q24h for 4 days.
  • Alternate Regimen (If methicillin resistant staphylococcus aureus is suspected): Vancomycin 10 mg/kg q8h OR Linezolid 10 mg/kg q8h
  • Empiric therapy,Children (> 3 months) Outpatient Therapy
  • pathogen specific regimen (bacteria)
  • (A) Streptococcus pneumoniae
  • (1) Penicillin nonresistant; MIC < 2 mg / mL
  • (2) Penicillin resistant; MIC > 2 mg / mL
  • Preferred Regimen (Agents chosen on the basis of susceptibililty) : Cefotaxime 1 g IM/IV q12h OR Ceftriaxone 1 g IV q24h, 2 g daily for patients at risk OR Fluoroquinolone
  • Alternative Regimen: Vancomycin 45-60 mg/kg/day divided q8-12h (max: 2000 mg/dose) for 7-21 days depending on severity OR Linezolid 600 mg PO/IV q12h for 10-14 days OR Amoxicillin 875 mg PO q12h or 500 mg q8 ( 3 g/day with penicillin MIC 4 ≤ microgram / mL)
  • (B)Haemophilus influenzae
  • (1) Non–B-lactamase producing
  • (2) B-lactamase producing
  • (C) Bacillus anthracis (inhalation)
  • (D) Enterobacteriaceae
  • (E)Pseudomonas aeruginosa
  • (F)Staphylococcus aureus
  • (1) Methicillin susceptible
  • (2) Methicillin resistant
  • Preferred Regimen : Vancomycin 45-60 mg/kg/day divided q8-12h (max: 2000 mg/dose) for 7-21 days OR Linezolid 600 mg PO/IV q12h for 10-14 days
  • Alternative Regimen: TMP-SMX 1-2 double-strength tablets (800/160 mg) q12-24h
  • (G)Bordetella pertussis
  • Preferred Regimen: Macrolide
  • Alternate Regimen: TMP-SMX 1-2 double-strength tablets (800/160 mg) q12-24h
  • (H) Anaerobe (aspiration)
  • (I) Mycobacterium tuberculosis
  • Preferred Regimen: Isoniazid 5 mg/kg/day q24h (usual dose: 300 mg/day) AND Rifampin 10 mg/kg/day (maximum: 600 mg / day) AND Ethambutol 5-25 mg/kg (maximum dose: 1.6 g) AND Pyrazinamide 1000 - 2000 mg / day
  • Alternate Regimen: Click here for more treatment regimens
  • (J) Yersinisa pestis
  • pathogen specific regimen (atypical bacteria)
  • (A) Mycoplasma pneumoniae
  • (B) Chlamydophila pneumoniae
  • (C) Legionella species
  • (D)Chlamydophila psittaci
  • (E) Coxiella burnetii
  • (F) Francisella tularensis
  • (G) Burkholderia pseudomallei
  • (H) Acinetobacter species
  • pathogen specific regimen (viral)
  • Influenza virus
  • Preferred Regimen: Oseltamivir 75 mg PO q12h for 5 days (initiated within 48 hours of onset of symptoms) OR Zanamivir Two inhalations (10 mg total) q12h for 5 days (Doses on first day should be separated by at least 2 hours; on subsequent days, doses should be spaced by ~12 hours)
  • pathogen specific regimen (fungal)
  • (A) Coccidioides species
Note: No therapy is indicated for uncomplicated infection, treat only if complicated infection
  • (B) Histoplasmosis
  • (C) Blastomycosis

Pneumonia, concomitant influenza

Pneumonia, Cytomegalovirus

Pneumonia, Haemophilus Influenza

Pneumonia, health care-associated

Pneumonia, hospital-acquired

Pneumonia, Klebsiella

Pneumonia, Legionella

Pneumonia, Lung abscess

Pneumonia, Meliodosis

Pneumonia, Moraxella catarrhalis

Pneumonia, Mycoplasma

Pneumonia, neutropenic patient

Pneumonia, Nocardia

Pneumonia, post-influenza

Pneumonia, Pseuodomonas

Pneumonia, Staphylococcus aureus

Pneumonia, Stenotrophomonas

Pneumonia, Streptococcus pneumoniae

Pneumonia, Tularemia

Pneumonia, Yersinia pestis

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