What is the inpatient empiric therapy regimen of community-acquired pneumonia (CAP)?

Updated: Jul 22, 2021
  • Author: Folusakin O Ayoade, MD; Chief Editor: Thomas E Herchline, MD  more...
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Answer

Answer

In this setting, empiric antibiotic regimens are designed to treat S aureus, gram-negative enteric bacilli (eg, Klebsiella pneumoniae) as well as typical pathogens (eg, S pneumoniaeH influenzae, and M catarrhalis) and atypical pathogens (eg, Legionella pneumophiliaM pneumoniae, and C pneumoniae). Therapy is started as soon as CAP is suspected as the diagnosis and ideally within 4 hours of presentation.

Factors to determine the antibiotic regimen depend on the likelihood that MRSA or Pseudomonas is present. Risk factors for MRSA or Pseudomonas infection are known colonization or prior infection with these organisms, particularly from a respiratory tract specimen, and recent hospitalization within the past 3 months, with usage of intravenous (IV) antibiotics

Without suspicion for MRSA or Pseudomonas

  • Combination of a beta-lactam (ampicillin-sulbactam 1.5-3 g IV q6h  or  ceftriaxone 1-2 g IV q24h  or   cefotaxime 1-2 g IV q8h  or  ceftaroline 600 mg IV q12h)  plus  azithromycin 500 mg IV/PO q24h  or  doxycycline 100 mg PO BID  or
  • Levofloxacin 750 mg IV or PO q24h  or
  • Moxifloxacin 400 mg IV or PO q24h  or

With known colonization or prior infection with Pseudomonas, recent hospitalization with IV antibiotic use, or other strong suspicion for pseudomonal infection

  • Combination therapy with both an antipseudomonal beta-lactam (pipericillin- tazobactam 4.5 g IV q6h  or  cefepime 2 g IV q8h or  ceftazidime 2 g IV q8h  or  meropenem 1 g IV q8h  or  imipenem 500 mg IV q6h) plus  an antipseudomonal fluoroquinolone (ciprofloxacin 400 mg IV q8h or Levofloxacin 750 mg IV q24h)

With known colonization or prior infection with MRSA or other strong suspicion for MRSA infection

  • Add vancomycin 15 to 20 mg/kg/dose IV every 8 to 12 hours initially and adjust to therapeutic monitoring  or linezolid 600 mg IV every 12 hours

Contradictions to macrolides and fluroquinolones

  • Combination of a beta-lactam (ampicillin-sulbactam 1.5-3 g IV q6h  or  ceftriaxone 1-2 g IV q24h  or   cefotaxime 1-2 g IV q8h  or  ceftaroline 600 mg IV q12h)  and doxycycline 100 mg BID

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