Selecting a Treatment Regimen
Table 2. Initial Empirical Antibiotic Therapy for Suspected Bacterial CAP
Patient Variable
OUTPATIENT Previously healthy
No recent antibiotic therapy within previous 3 months, and no risk for drug-resistant S. pneumoniae
Comorbidities
COPD, diabetes, chronic heart, liver, lung or renal disease, malignancy, alcoholism, asplenia, immunosuppressing conditions or use of immunosuppressive drugs, use of antimicrobials within last 3 months
Respiratory fluoroquinolone (moxifloxacin, gemifloxacin, levofloxacin [750 mg†
])*
OR β-Lactam (high-dose amoxicillin [1 g tid], or amoxicillin- clavulanate [2 g bid using the 1000 mg/62.5 mg extended- release tablet formulation]), plus a macrolide (doxycycline is an alternative to the macrolide). Alternative β-lactams include ceſtriaxone, cefpodoxime, cefuroxime (500 mg bid)*
In regions with a 25% or higher rate of infection with high-level (MIC ≥16 μg/mL) macrolide-resistant S. pneumoniae
For any patient, including those without comorbidities
Respiratory fluoroquinolone (moxifloxacin, gemifloxacin, levofloxacin [750 mg†
])*
OR β-Lactam (high-dose amoxicillin [1 g tid] , or amoxicillin- clavulanate [2 g bid using the 1000 mg/62.5 mg extended- release tablet formulation]), plus a macrolide (doxycycline is an alternative to the macrolide). Alternative β-lactams include ceſtriaxone, cefpodoxime, cefuroxime (500 mg bid)*
* If patient received a macrolide in previous 3 months, use a fluoroquinolone and vice versa. † This dose for patients with normal renal function.
Table 3. Recommended Antimicrobials for Outpatient Treatment of CAP
Antimicrobial
Amoxicillin/clavulanate (Augmentin®
) Route β-Lactam/β-lactamase inhibitors PO 2 g bid †
mg/62.5 mg extended- release tablet formulation)
(using the 1000
> β-Lactams inactive against atypical pathogens
> Amoxicillin-clavulanate active against most H. influenzae, methicillin-susceptible S. aureus and anaerobes
Adult Dose* Comments Macrolide OR doxycycline Treatment Option (See Table 3 for dosage)
> Dose listed is specified for empirical therapy based on presence of risk factors for resistance, lower doses are adequate for penicillin- susceptible S. pneumoniae
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