Hospitalized Adults: Respiratory Tract Infections: Community-Acquired Pneumonia

PrintPrintPDFPDF

Doses provided in this table are for patients with normal renal and hepatic function. Click on drug link to go to dosing guidelines.  Some antimicrobials are restricted (ID-R).  Click on link for guidelines on obtaining authorization.

Diagnosis

Common Pathogens

Drug(s) of First Choice

Alternative Drug(s)

Comments

Community-Acquired Pneumonia 

Immunocompetent patient – Medical Ward

S. pneumoniae

Mycoplasma pneumoniae

Chlamydia pneumoniae

H. influenzae

Legionella pneumophilia

Klebsiella pneumoniae

(alcoholics)

No Recent antibiotic therapy:*

Ceftriaxone 1 g IV daily

PLUS

Doxycycline 100 mg PO/IV q12h 

For severe PCN allergy:

Levofloxacin 750 mg PO/IV daily

OR

MoxifloxacinID-R: SFGH 400 mg PO/IV daily 

ID consultation is recommended if ICU admission or high level PCN-resistant pneumococci documented.

 

*If patient has had recent antibiotic therapy, antibiotics from a different class should be selected (i.e. recent use of a fluoroquinolone should dictate selection of a non-fluoroquinolone regimen, and vice versa).

 

Consider influenza testing and treatment with oseltamivir.

Community-Acquired Pneumonia

Immunocompetent patient – ICU 

 


S. pneumoniae

Mycoplasma pneumoniae

Chlamydia pneumoniae

H. influenzae

Legionella pneumophilia

Klebsiella pneumoniae

(alcoholics)

S. aureus

Ceftriaxone 1 g IV daily

PLUS

Azithromycin 500 mg IV daily

WITH OR WITHOUT*:

Vancomycin

For severe PCN allergy:

Vancomycin

PLUS one of:

Levofloxacin 750 mg IV daily

OR

MoxifloxacinID-R: SFGH 400 mg IV daily 

* MRSA risk factors: prior influenza, presence cavitary disease, empyema.

 

Consider influenza testing and treatment with oseltamivir.

 

If no microbiologic confirmation of MRSA then discontinue vancomycin.

 

See HCAP for risk factors for infection with Pseudomonas aeruginosa.