Update of Practice Guidelines for the Management of Community-Acquired Pneumonia in Immunocompetent Adults
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2003
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Abstract
Recent antibiotic therapy b A respiratory fluoroquinolone c alone, an advanced macrolide d plus high-dose amoxicillin, e or an advanced macrolide plus high-dose amoxicillin-clavulanate f Comorbidities (COPD, diabetes, renal or congestive heart failure, or malignancy) No recent antibiotic therapy An advanced macrolide d or a respiratory fluoroquinolone Recent antibiotic therapy A respiratory fluoroquinolone c alone or an advanced macrolide plus a b-lactam g Suspected aspiration with infection Amoxicillin-clavulanate or clindamycin Influenza with bacterial superinfection A b-lactam g or a respiratory fluoroquinolone Inpatient Medical ward No recent antibiotic therapy A respiratory fluoroquinolone alone or an advanced macrolide plus a b-lactam h Recent antibiotic therapy An advanced macrolide plus a b-lactam or a respiratory fluoroquinolone alone (regimen selected will depend on nature of recent antibiotic therapy) ICU Pseudomonas infection is not an issue A b-lactam h plus either an advanced macrolide or a respiratory fluoroquinolone Pseudomonas infection is not an issue but patient has a b-lactam allergy A respiratory fluoroquinolone, with or without clindamycin Pseudomonas infection is an issue i Either (1) an antipseudomonal agent j plus ciprofloxacin, or (2) an antipseudomonal agent plus an aminoglycoside k plus a respiratory fluoroquinolone or a macrolide Pseudomonas infection is an issue but the patient has a b-lactam allergy Either (1) aztreonam plus levofloxacin, l or (2) aztreonam plus moxifloxacin or gatifloxacin, with or without an aminoglycoside Nursing home Receiving treatment in nursing home A respiratory fluoroquinolone alone or amoxicillin-clavulanate plus an advanced macrolide Hospitalized Same as for medical ward and ICU NOTE.COPD, chronic obstructive pulmonary disease; ICU, intensive care unit.a Erythromycin, azithromycin, or clarithromycin.b That is, the patient was given a course of antibiotic(s) for treatment of any infection within the past 3 months, excluding the current episode of infection.Such treatment is a risk factor for drug-resistant Streptococcus pneumoniae and possibly for infection with gram-negative bacilli.Depending on the class of antibiotics recently given, one or other of the suggested options may be selected.Recent use of a fluoroquinolone should dictate selection of a nonfluoroquinolone regimen, and vice versa.c Moxifloxacin, gatifloxacin, levofloxacin, or gemifloxacin (oral gemifloxacin only, which was approved by the US Food and Drug Administration on 4 April 2003 and which is the only fluoroquinolone approved for multidrug-resistant S. pneumoniae; not yet marketed).d Azithromycin or clarithromycin.e Dosage, 1 g po t.i.d.f Dosage, 2 g po b.i.d.g High-dose amoxicillin, high-dose amoxicillin-clavulanate, cefpodoxime, cefprozil, or cefuroxime.h Cefotaxime, ceftriaxone, ampicillin-sulbactam, or ertapenem; ertapenem was recently approved for such use (in once-daily parenteral treatment), but there is little experience thus far.i The antipseudomonal agents chosen reflect this concern.Risk factors for Pseudomonas infection include severe structural lung disease (e.g., bronchiectasis), and recent antibiotic therapy or stay in hospital (especially in the ICU).For patients with CAP in the ICU, coverage for S. pneumoniae and Legionella species must always be assured.Piperacillin-tazobactam, imipenem, meropenem, and cefepime are excellent b-lactams and are adequate for most S. pneumoniae and Haemophilus influenzae infections.They may be preferred when there is concern for relatively unusual CAP pathogens, such as Pseudomonas aeruginosa, Klebsiella species, and other gram-negative bacteria.j Piperacillin, piperacillin-tazobactam, imipenem, meropenem, or cefepime.k Data suggest that elderly patients receiving aminoglycosides have worse outcomes [47].l Dosage for hospitalized patients, 750 mg q.d.
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|---|---|
| Authors | Lionel A. Mandell, John G. Bartlett, Scott F. Dowell, Thomas M. File, Daniel M. Musher, Cynthia G. Whitney |
| Journal | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America |
| Year | 2003 |
| DOI |
10.1086/380488
|
| URL | |
| Keywords | Keywords not found |
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