Memory Joggers: Pneumonia - Presumptive Selection Of Antimicrobial Agents
For Treating Patients with Community Acquired Pneumonia
OUTPATIENTS
Generally preferred are (not in any particular order): doxycycline, a macrolide, or a fluoroquinolone
Selection considerations:
- These agents have activity against the most likely pathogens in this setting, which include S. pneumoniae, M. pneumoniae, Chlamydia pneumoniae
- Selection should be influenced by regional antibiotic susceptibility patterns for S. pneumoniae and the presence of other risk factors for drug-resistant S. pneumoniae
- Penicillin-resistant pneumococci may be resistant to macrolides and/or doxycycline
- For older patients or those with underlying disease, a fluoroquinolone may be a preferred choice; some authorities prefer to reserve fluoroquinolones for such patients.
HOSPITALIZED PATIENTS
GENERAL MEDICAL WARD
Generally preferred are: An extended spectrum cephalosporin combined with a macrolide or a ß-lactam/ß-lactamase inhibitor combined with a macrolide or a fluoroquinolone (alone)
INTENSIVE CARE UNIT
Generally preferred are: An extended spectrum cephalosporin or ß-lactam/ß-lactamase inhibitor plus either fluoroquinolone or macrolide
Alternatives for modifying factors:
Structural lung disease:
- antipseudomonal agents(piperacillin, piperacillin-tazobactam, carbapenum, or cefapime) plus a fluoroquinolone (including high-dose ciprofloxacin)
ß-Lactam allergy:
- fluoroquinolone ± clindamycin
Suspected aspiration:
- fluoroquinolone with or without clindamycin, metronidazole, or a ß-lactam/ß-lactamase inhibitor
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