American Thoracic Society Quick-Reference GUIDELINES Apps
Issue link: https://eguideline.guidelinecentral.com/i/1194279
6 Treatment ➤ For outpatient adults with comorbidities such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy; or asplenia we recommend (in no particular order of preference) (see Table 2): • Combination therapy: ▶ Amoxicillin/clavulanate 500 mg/125 mg three times daily, or amoxicillin/ clavulanate 875 mg/125 mg twice daily, or 2,000 mg/125 mg twice daily, or a cephalosporin (cefpodoxime 200 mg twice daily or cefuroxime 500 mg twice daily); and ▶ Macrolide (azithromycin 500 mg on first day then 250 mg daily, clarithromycin [500 mg twice daily or extended release 1,000 mg once daily]) (strong recommendation, moderate quality of evidence for combination therapy), or doxycycline 100 mg twice daily (conditional recommendation, low quality of evidence for combination therapy), or • Monotherapy: ▶ Respiratory fluoroquinolone (levofloxacin 750 mg daily, moxifloxacin 400 mg daily, or gemifloxacin 320 mg daily) (strong recommendation, moderate quality of evidence). 9. Empiric Antibiotics – Inpatient ➤ In inpatient adults with non-severe CAP without risk factors for MRSA or P. aeruginosa (see Section 11), we recommend the following empiric treatment regimens (in no order of preference): • combination therapy with a beta-lactam (ampicillin+sulbactam 1.5–3 g every 6 hours, cefotaxime 1–2 g every 8 hours, ceftriaxone 1–2 g daily, or ceftaroline 600 mg every 12 hours) and a macrolide (azithromycin 500 mg daily or clarithromycin 500 mg twice daily) (strong recommendation, high quality of evidence); or • monotherapy with a respiratory fluoroquinolone (levofloxacin 750 mg daily, moxifloxacin 400 mg daily) (strong recommendation, high quality of evidence). ➤ A third option for adults with CAP who have contraindications to both macrolides and fluoroquinolones is: • combination therapy with a beta-lactam (ampicillin+sulbactam, cefotaxime, ceftaroline or ceftriaxone, doses as above) and doxycycline 100 mg twice daily (conditional recommendation, low quality of evidence). ➤ In inpatient adults with severe CAP without risk factors for MRSA or P. aeruginosa, we recommend (Note: specific agents and doses are the same as above): • a beta-lactam plus a macrolide (strong recommendation, moderate quality of evidence); or • a beta-lactam plus a respiratory fluoroquinolone (strong recommendation, moderate quality of evidence).