10
Treatment
Table 3. Initial Treatment Strategies for Inpatients with CAP
by Level of Severity and Risk for Drug Resistance
Standard Regimen
Prior Respiratory
Isolation of MRSA
Non-severe inpatient
pneumonia
a
Beta-lactam +
macrolide
b
or respiratory
fluroquinolone
c
Add MRSA coverage
d
and
obtain cultures/nasal PCR
to allow de-escalation or
confirmation of need for
continued therapy
Severe inpatient
pneumonia
c
Beta-lactam + macrolide
or Beta-lactam +
fluroquinolone
Add MRSA coverage
d
and
obtain cultures/nasal PCR
to allow de-escalation or
confirmation of need for
continued therapy
a
As defined by 2007 ATS/IDSA CAP severity criteria guidelines (See Table 1)
b
Ampicillin + sulbactam 1.5–3 g every 6 hours, cefotaxime 1–2 g every 8 hours, ceriaxone 1–2 g
daily, or cearoline 600 mg every 12 hours AND azithromycin 500 mg daily or clarithromycin
500 mg twice daily.
c
Levofloxacin 750 mg daily or moxifloxacin 400 mg daily.
d
Per the 2016 ATS/IDSA HAP/VAP guidelines: vancomycin (15 mg/kg every 12 h, adjust based on
levels) or linezolid (600 mg every 12 h).
e
Per the 2016 ATS/IDSA HAP/VAP guidelines: piperacillin-tazobactam (4.5 g every 6 h), cefepime
(2 g every 8 h), ceazidime (2 g every 8 h), imipenem (500 mg every 6 h), meropenem (1 g every
8 h), or aztreonam (2 g every 8 h). Does not include coverage for extended spectrum beta-
lactamase–producing enterobacteraceae, which should be considered based only on patient or local
microbiological data.
