Sandbox ID Lower Respiratory Tract
Acute bacterial exacerbations of chronic bronchitis
Bronchiectasis
Bronchiolitis
Bronchitis
Cystic fibrosis
Empyema
Influenza
Inhalational anthrax, Prophylaxis
Inhalational anthrax, Treatment
Pertussis
Pneumonia, Acinetobacter
Pneumonia, Actinomycosis
Pneumonia, Anaerobes
Pneumonia, Aspiration pneumonia
Pneumonia, Chlamydophila
Pneumonia, community-acquired
- Community acquired pneumonia
- Empiric therapy
- Adult; Outpatient treatment
- (1) Previously healthy and no use of antimicrobials within the previous 3 months.
- Preferred regimen : Azithromycin 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 OR Azithromycin 500 mg IV as a single dose OR Clarithromycin 250 mg q12h for 7-14 days OR 1000 mg q24h for 7 days OR Erythromycin 250-500 mg q6-12h (max: 4 g/day)
- Alternative regimen : Doxycycline 100 mg PO/IV q12h (Weak recommendation).
- (2) Presence of comorbidities such as chronic heart, lung, liver or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressing conditions or use of immunosuppressing drugs; or use of antimicrobials within the previous 3 months (in which case an alternative from a different class should be selected)
- Preferred regimen (1) : Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 days OR Moxifloxacin 400 mg PO/IV q24h for 7-14 days OR Gemifloxacin 320 mg PO q24h for 5 or 7 days
- Preferred Regimen (2) : Amoxicillin 875 mg PO q12h or 500 mg q8h OR Amoxicillin-clavulanate 2 g q12h OR Ceftriaxone 1 g IV q24h, (2 g q24h for patients at risk) OR Cefpodoxime 200 mg PO q12h for 14 days OR Cefuroxime 750 mg IM/IV q8h AND Macrolide OR Doxycycline 100 mg PO/IV q12h
- (3) In regions with a high rate (125%) of infection with high-level (MIC 16 mg/mL) macrolide-resistant Streptococcus pneumoniae,
- Inpatients, non-ICU treatment
- Preferred Regimen : Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 days OR Moxifloxacin 400 mg PO/IV q24h for 7-14 days OR Gemifloxacin 320 mg PO q24h for 5 or 7 days OR Amoxicillin 1 g q8h OR Amoxicillin-clavulanate 2 g q12h
- Alternative Regimen : Ceftriaxone 1 g IV q24h, (2 g q24h for patients at risk) OR Cefpodoxime 200 mg PO q12h for 14 days OR Cefuroxime 750 mg IM/IV q8h
- Adult Inpatient Therapy, ICU
- Preferred Regimen : Cefotaxime I.M., I.V.: 1 g q12h OR Ceftriaxone 1 g IV q24h, 2 g/day for patients at risk OR Ampicillin-sulbactam 1.5-3 g IV q6h AND Azithromycin 500 mg/day PO once, followed by 250 mg q24h for 4 days OR Ciprofloxacin 500-750 mg q12h for 7-14 days OR[Levofloxacin ]]500 mg q24h for 7-14 days or 750 mg q24h for 5 days OR Moxifloxacin 400 mg PO/IV q24h for 7-14 days OR Gemifloxacin Oral: 320 mg q24h for 5 or 7 days
- Alternative Regimen (For penicillin allergy): Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 day OR [[Moxifloxacin 400 mg q24h PO/IV for 7-14 days OR Gemifloxacin 320 mg PO q24h for 5 or 7 days AND Aztreonam I.V.: 2 g q6-8h (max: 8 g/day)
- Adult Special Concerns - Pseudomonas
- Preferred Regimen (1): Piperacillin-tazobactam 3.375 g IV q6h for 7-10 days OR Cefepime 1-2 g q12h for 10 days OR Imipenem 500 mg IV q6h OR Meropenem 500 mg IV q8h AND Ciprofloxacin 500-750 mg q12h for 7-14 days OR Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 day
- Preferred Regimen (2): Piperacillin-tazobactam 3.375 g IV q6h for 7-10 days OR Cefepime 1-2 g q12h for 10 days OR Imipenem 500 mg IV q6h OR Meropenem 500 mg IV q8h OR Template:Add Aminoglycoside Template:Add Azithromycin Oral: 500 mg on day 1 followed by 250 mg q24h on days 2-5 OR Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 days OR Moxifloxacin 400 mg PO/IV q24h for 7-14 days OR Gemifloxacin 320 mg PO q24h for 5 or 7 days
- For penicillin-allergic patients, substitute the B-lactam for Aztreonam 2 g IV q6-8h (max 8 g/day)
- Adult Special Concerns : - methicillin resistent staphylococcus aureus ,Add the following to the selected regimen
- Preferred regimen: Vancomycin 45-60 mg/kg/day divided q8-12h OR Linezolid 600 mg PO/IV q12h for 10-14 days.