| Diagnosis | Common Pathogens | Drug(s) of First Choice | Alternative Drug(s) | Comments | Expected Duration |
|---|---|---|---|---|---|
|
Immunocompetent patient admitted to the Medical Ward |
Respiratory viruses S. pneumoniae Mycoplasma pneumoniae Chlamydia pneumoniae H. influenzae Legionella pneumophilia Klebsiella pneumoniae (alcoholics) |
No Recent antibiotic therapy:* PLUS Doxycycline |
For severe beta-lactam allergy: Levofloxacin 750mg PO/IV daily OR Moxifloxacin 400mg 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 Consider coverage for MRSA and/or Pseudomonas aeruginosa in patients with respiratory isolation of these organisms or receipt of parenteral antibiotics within 90 days. If these organisms are not isolated, deescalate antibiotics |
5 days |
|
Immunocompetent patient ICU |
Respiratory viruses S. pneumoniae Mycoplasma pneumoniae Chlamydia pneumoniae H. influenzae Legionella pneumophilia Klebsiella pneumoniae (alcoholics) S. aureus |
PLUS Azithromycin 500mg IV daily WITH OR WITHOUT*: |
For severe beta-lactam allergy: PLUS one of EITHER: Levofloxacin 750mg IV daily OR Moxifloxacin 400mg IV daily |
Consider coverage for MRSA and/or Pseudomonas aeruginosa in patients with respiratory isolation of these organisms or receipt of parenteral antibiotics within 90 days. Other MRSA risk factors to consider: recent influenza, presence of cavitary disease, empyema Consider influenza testing and treatment with oseltamivir If no microbiologic confirmation of MRSA then discontinue vancomycin. If coverage for Pseudomonas is started, obtain blood and sputum cultures and deescalate if this organism is not isolated. |
5-7 days |
American Journal of Respiratory and Critical Care Medicine, Volume 200, Issue 7, 1 October 2019, Pages e45-e67, https://www.atsjournals.org/doi/full/10.1164/rccm.201908-1581ST