4 5 Medications to Treat Pneumonia The medications for outpatient setting no

4 5 medications to treat pneumonia the medications

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4-5). Medications to Treat Pneumonia The medications for outpatient setting, no comorbidities/previously healthy; no risk factors for drug-resistant S pneumoniae: azithromycin 500mg PO one dose, then 250mg PO daily for 4 days or extended-release 2g PO as a single dose or clarithromycin 500mg PO bid or extended-release 1000mg PO q24 or Doxycycline 100mg PO bid. If received prior antibiotic within 3 months: azithromycin or clarithromycin plus amoxicillin 1gm PO q8 hours or amoxicillin-clavulanate 2gm PO q12 hour or respiratory fluoroquinolone (e.g., levofloxacin 750mg PO daily or moxifloxacin 400mg PO daily. If comorbidities present (e.g., alcoholism, bronchiectasis/cystic fibrosis, COPD, IV drug user, post influenza, asplenia, diabetes mellitus, lung/liver/renal disease): levofloxacin 750mg PO q24 hour or moxifloxacin 400mg PO q24 or combination of a beta-lactam (amoxicillin 1gm PO q8 hour or amoxicillin-clavulanate 2gm PO q12 hour or ceftriaxone 1gm IV/IM q24 hour or cefuroxime 500mg PO bid) plus a macrolide (azithromycin or clarithromycin). Duration of therapy: minimum 5 days, should be afebrile 48-
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72 hours, or until afebrile 3 days; longer duration of therapy may be needed if initial therapy was not active against identified pathogen or if it was complicated by extrapulmonary infections (Donovan, 2018). Inpatient, non-ICU: levofloxacin 750mg IV or PO q 24 hour or moxifloxacin 400mg IV or PO q 24 hour or combination of a beta-lactam (ceftriaxone 1gm IV q 24 hour or cefotaxime 1gm IV q8 hour or ceftaroline 600mg IV q12 hour) plus azithromycin 500mg IV q24 hour. Duration of therapy: minimum 5 days, should be afebrile for 48-72 hours, stable blood pressure, adequate oral intake, and room air oxygen saturation of greater than 90%; longer duration may be needed in some cases (Donovan, 2018). Inpatient, ICU: combination of a beta-lactam (ceftriaxone 1gm IV q24 hour or cefotaxime 1gm IV q8 hour or ceftaroline 600mg IV q12 hour) plus azithromycin 500mg IV q24 hour or levofloxacin 750mg IV or PO q24 hour or moxifloxacin 400g IV or PO q24 hour. If gram- negative rod pneumonia (Pseudomonas) suspected, due to alcoholism with necrotizing pneumoniae, chronic bronchiectasis/tracheobronchitis due to cystic fibrosis, mechanical ventilation, febrile neutropenia with pulmonary infiltrate, septic shock with organ failure: piperacillin-tazobactam 4.5gm IV q6 hour or 3.375gm IV q4 hour or 4-h infusion of 3.375gm q8 hour or cefepime 2gm IV q12 hour or imipenem/cilastatin 500mg IV q6 hour or meropenem 1gm IV q8 hour plus levofloxacin 750mg IV q24 hour or moxifloxacin 400mg IV or PO q24 hour or azithromycin 500g IV q 24 hour. Duration of therapy: 10-14 days. If concomitant with or post influenza, add: vancomycin 15mg/kg IV q12 hour or linezolid 600mg IV bid. Risk of aspiration pneumonia/anaerobic lung infection/lung abscess: ampicillin-sulbactam 3gm IV q6 hour or ceftriaxone 1gm IV q24 hour plus metronidazole 500mg IV q6 hour or moxifloxacin 400mg IV or PO q 24 hour or piperacillin-tazobactam 3.375gm IV q6 hour, if methicillin-resistant S aureus
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