Table #USUNIĘTA# Recommended empiric antibiotics for community-acquired pneumonia

Outpatient treatment

1. Previously healthy and no use of antimicrobials within the previous 3 months:

– A macrolide

– Doxycycline

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):

– A respiratory fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg])

– A beta-lactam plus a macrolide

3. In regions with a high rate (>25%) of infection with high-level (MIC ≥16 microg/mL) macrolide-resistant Streptococcus pneumoniae, consider use of alternative agents listed above in point 2 for patients without comorbidities

Inpatients, non-ICU treatment

– A respiratory fluoroquinolone

– A beta-lactam plus a macrolide

Inpatients, ICU treatment

A beta-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) plus either azithromycin or a respiratory fluoroquinolone (for penicillin-allergic patients, a respiratory fluoroquinolone and aztreonam are recommended)

Special concerns

If Pseudomonas is a consideration:

– An antipneumococcal, antipseudomonal beta-lactam (piperacillin/tazobactam, cefepime, imipenem, or meropenem) plus either ciprofloxacin or levofloxacin (750 mg)

or

– The above beta-lactam plus an aminoglycoside and azithromycin

or

– The above beta-lactam plus an aminoglycoside and an antipneumococcal fluoroquinolone (for penicillin-allergic patients, substitute aztreonam for above beta-lactam)

If CA-MRSA is a consideration, add vancomycin or linezolid.

Source: Clin Infect Dis. 2007;44 Suppl 2:S27-72.

CA-MRSA, community-acquired methicillin-resistant Staphylococcus aureus; ICU, intensive care unit; MIC, minimum inhibitory concentration.