Diagnosis
ÎThe IDSA recommends "high-dose" amoxicillin-clavulanate for: > children and adults with ABRS from geographic regions with high endemic rates (≥ 10%) of invasive penicillin-nonsusceptible (PNS) S. pneumoniae
> those at risk of antibiotic resistance ▶ attendance at day-care ▶ age < 2 or > 65 years ▶ recent hospitalization ▶ antibiotic use within the past month ▶ those who are immunocompromised (WR-M).
of ABRS (WR-M).
ÎMacrolides (clarithromycin and azithromycin) are NOT recommended for empiric therapy due to high rates of resistance among S. pneumoniae (~30%) (SR-M).
ÎTrimethoprim/sulfamethoxazole (TMP/SMX) is NOT recommended for empirical therapy due to high rates of resistance among both S. pneumoniae and H. influenzae (~30%-40%) (SR-M).
ÎDoxycycline may be used as an alternative regimen to amoxicillin- clavulanate for initial empiric antimicrobial therapy of ABRS in adults since it remains highly active against respiratory pathogens and has excellent pharmacokinetic/pharmacodynamic properties (WR-L).
ÎSecond and third generation oral cephalosporins are no longer recommended for empiric monotherapy of ABRS due to variable rates of resistance among S. pneumoniae. Combination therapy with a third generation oral cephalosporin (cefixime or cefpodoxime) plus clindamycin may be used as second line therapy for children with non-type I penicillin allergy or from geographic regions with high endemic rates of PNS S. pneumoniae (WR-M).
ÎThe IDSA recommends either doxycycline (not suitable for children) or a respiratory fluoroquinolone (levofloxacin or moxifloxacin) as alternative agents for empiric antimicrobial therapy in adults who are allergic to penicillin (SR-M).
ÎThe IDSA recommends levofloxacin for children with a history of type I hypersensitivity to penicillin. Combination therapy with clindamycin plus a third generation oral cephalosporin (cefixime or cefpodoxime) is recommended in children with a history of non-type I hypersensitivity to penicillin (WR-L).
ÎAlthough S. aureus (including methicillin-resistant S. aureus [MRSA]) is a potential pathogen in ABRS, based on current data routine antimicrobial coverage for S. aureus or MRSA during initial empiric therapy of ABRS is NOT recommended (SR-M).
> those with severe infection (eg, evidence of systemic toxicity with fever ≥ 39ºC [102ºF] and threat of suppurative complications)
ÎThe IDSA recommends a β-lactam agent (amoxicillin-clavulanate) rather than a respiratory fluoroquinolone for initial empiric antimicrobial therapy
