Sandbox ID Lower Respiratory Tract: Difference between revisions

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:::*(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)
:::*(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 (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
::::* 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 [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 {{or}} [[Doxycycline]] 100 mg PO/IV q12h)


::* (B) Inpatient Therapy (in regions with a high rate (125%) of infection with high-level (MIC 16 mg/mL) macrolide-resistant Streptococcus pneumoniae)
::* (B) Inpatient Therapy (in regions with a high rate (125%) of infection with high-level (minimum inhibitory concentration 16 mg/mL) macrolide-resistant Streptococcus pneumoniae)
:::* (1) Non-ICU treatment
:::* (1) Non-ICU treatment
::::* 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 : [[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
::::* 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
:::* (2) ICU treatment
::::* 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 : ([[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)
::::* 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  
::* (C) Special Concerns  
:::* (1) Pseudomonas
:::* (1) Pseudomonas
::::* 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 (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 (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
::::* 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)
:::: Note : For penicillin-allergic patients, substitute the B-lactam for Aztreonam 2 g IV q6-8h (maximum 8 g/day)
:::* (2) Methicillin resistant staphylococcus aureus ,Add the following to the selected regimen
:::* (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.
::::* Preferred regimen: [[Vancomycin]] 45-60 mg/kg/day divided q8-12h {{or}} [[Linezolid]] 600 mg PO/IV q12h for 10-14 days.
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::* 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
::* 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 (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.
::: Note (2) : If Chlamydia trachomatis is suspected, add the following [[Erythromycin]] 12.5 mg/kg PO or IV qid for 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
::* Alternate Regimen (If methicillin resistant staphylococcus aureus  is suspected): [[Vancomycin]] 10 mg/kg q8h {{or}} [[Linezolid]] 10 mg/kg q8h


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:*'''pathogen specific regimen (bacteria)'''
:*'''pathogen specific regimen (bacteria)'''
::* (A) Streptococcus pneumoniae
::* (A) Streptococcus pneumoniae
:::* (1) Penicillin nonresistant; MIC < 2 mg / mL
:::* (1) Penicillin nonresistant; minimum inhibitory concentration < 2 mg / mL
::::* Preferred Regimen : [[Penicillin G]] 2-3 million units IV q4h {{or}} [[Amoxicillin]] 875 mg PO q12h or 500 mg q8h
::::* 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]]
::::* Alternative Regimen : [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h {{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 (maximum: 1800 mg/day) {{or}} [[Clindamycin]] 1.2-2.7 g/day IM/IV in 2-4 divided doses (maximum:4800 mg/day) {{or}} [[Doxycycline]] 100 mg PI/IV q12h {{or}} Respiratory [[fluoroquinolone]]
:::* (2) Penicillin resistant; MIC > 2 mg / mL
:::* (2) Penicillin resistant; minimum inhibitory concentration > 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]]
::::* 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}} [[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h
::::* 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)
::::* Alternative Regimen: [[Vancomycin]] 45-60 mg/kg/day divided q8-12h (maximum: 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 ,minimum inhibitory concentration 4 ≤ microgram / mL)


::* (B)Haemophilus influenzae
::* (B)Haemophilus influenzae
:::* (1) Non–B-lactamase producing
:::* (1) Non–B-lactamase producing
::::* Preferred Regimen: [[Amoxicillin]] 875 mg PO q12h or 500 mg q8h
::::* 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
::::* Alternative Regimen : [[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h {{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
:::* (2) B-lactamase producing
::::* Preferred Regimen: 2nd or 3rd Generation [[Cephalosporin]] {{or}} [[Amoxicillin-clavulanate]] 2 g q12h
::::* 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
::::* Alternative Regimen: [[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h {{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)
::* (C) Bacillus anthracis (inhalation)
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::* (D) Enterobacteriaceae
::* (D) Enterobacteriaceae
:::* Preferred Regimen: 3rd generation cephalosporin {{or}} [[Carbapenem]] (†) (drug of choice if extended-spectrum b-lactamase producer)
:::* 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]]
:::* Alternate Regimen : b-Lactam / b-lactamase inhibitor (‡) {{or}} [[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h (†)= [[Imipenem]]-[[cilastatin]], [[meropenem]], [[ertapenem]] (‡)= Piperacillin-tazobactam for gram-negative bacilli, [[ticarcillin-clavulanate]], [[ampicillin-sulbactam]] or [[amoxicillin-clavulanate]]


::* (E)Pseudomonas aeruginosa
::* (E)Pseudomonas aeruginosa
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::* (G)Bordetella pertussis
::* (G)Bordetella pertussis
:::* Preferred Regimen: [[Macrolide]]
:::* Preferred Regimen:[[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h
:::* Alternate Regimen: [[TMP-SMX]] 1-2 double-strength tablets (800/160 mg) q12-24h
:::* Alternate Regimen: [[TMP-SMX]] 1-2 double-strength tablets (800/160 mg) q12-24h


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::* (J) Yersinisa pestis
::* (J) Yersinisa pestis
:::* Preferred Regimen: [[Streptomycin]] 15 mg/kg/day (max 1 g/day) {{or}} [[Gentamicin]] 7 mg/kg/day
:::* 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]]
:::* Alternate Regimen: [[Doxycycline]] 100 mg PO/IV q12h {{or}} [[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h


:*'''pathogen specific regimen (atypical bacteria)'''
:*'''pathogen specific regimen (atypical bacteria)'''
::* (A) Mycoplasma pneumoniae
::* (A) Mycoplasma pneumoniae
:::* Preferred Regimen: [[Macrolide]] {{or}} [[Tetracycline]] Oral: 250-500 mg q6h
:::* Preferred Regimen:[[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h {{or}} [[Tetracycline]] Oral: 250-500 mg q6h
:::* Alternate Regimen: [[Fluoroquinolone]]
:::* Alternate Regimen: [[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h


::* (B) Chlamydophila pneumoniae
::* (B) Chlamydophila pneumoniae
:::* Preferred Regimen: [[Macrolide]] {{or}} [[Tetracycline]] 250-500 mg PO q6h
:::* Preferred Regimen: [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h {{or}} [[Tetracycline]] 250-500 mg PO q6h
:::* Alternate Regimen: [[Fluoroquinolone]]
:::* Alternate Regimen: [[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h
 
::* (C) Legionella species
::* (C) Legionella species
:::* Preferred Regimen: [[Fluoroquinolone]] {{or}} [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h
:::* Preferred Regimen: [[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h {{or}} [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h
:::* Alternate Regimen: [[Doxycycline]] 100 mg PO/IV q12h
:::* Alternate Regimen: [[Doxycycline]] 100 mg PO/IV q12h


::* (D)Chlamydophila psittaci
::* (D)Chlamydophila psittaci
:::* Preferred Regimen: [[Tetracycline]] 250-500 mg PO q6h
:::* Preferred Regimen: [[Tetracycline]] 250-500 mg PO q6h
:::* Alternate Regimen: [[Macrolide]]
:::* Alternate Regimen: [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h


::* (E) Coxiella burnetii
::* (E) Coxiella burnetii
:::* Preferred Regimen: [[Tetracycline]] 250-500 mg PO q6h
:::* Preferred Regimen: [[Tetracycline]] 250-500 mg PO q6h
:::* Alternate Regimen: [[Macrolide]]
:::* Alternate Regimen: [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h


::* (F) Francisella tularensis
::* (F) Francisella tularensis
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::* (G) Burkholderia pseudomallei
::* (G) Burkholderia pseudomallei
:::* Preferred Regimen : [[Carbapenem]] {{or}} [[Ceftazidime]] 0.5-1 g q8h
:::* 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
:::* Alternate Regimen: [[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h {{or}} [[TMP-SMX]] 1-2 double-strength tablets (800/160 mg) q12-24h


::* (H) Acinetobacter species
::* (H) Acinetobacter species

Revision as of 15:59, 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 (minimum inhibitory concentration 16 mg/mL) macrolide-resistant Streptococcus pneumoniae)
  • (1) Non-ICU treatment
  • (2) ICU treatment
  • (C) Special Concerns
  • (1) Pseudomonas
Note : For penicillin-allergic patients, substitute the B-lactam for Aztreonam 2 g IV q6-8h (maximum 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 for 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; minimum inhibitory concentration < 2 mg / mL
  • (2) Penicillin resistant; minimum inhibitory concentration > 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 levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h
  • Alternative Regimen: Vancomycin 45-60 mg/kg/day divided q8-12h (maximum: 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 ,minimum inhibitory concentration 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:Azithromycin 500 mg PO on day 1 followed by 250 mg q24h
  • 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
  • Preferred Regimen: Tetracycline 250-500 mg PO q6h
  • Alternate Regimen: Azithromycin 500 mg PO on day 1 followed by 250 mg q24h
  • (E) Coxiella burnetii
  • Preferred Regimen: Tetracycline 250-500 mg PO q6h
  • Alternate Regimen: Azithromycin 500 mg PO on day 1 followed by 250 mg q24h
  • (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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