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BRONCHOPULMONARY - Pneumonia - Community-acquired Empiric therapy: Advanced generation macrolide, doxycycline or fluoroquinolone with good antipneumococcal activity. (Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Chlamydia pneumoniae, Legionella sp.) |
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No Comorbidities |
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With Comorbidities (chronic heart, liver, renal disease, DM, ETOH, CA or asplenic) |
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Beta Lactam Choice Amoxicillin-Clavulanate 500mg/125mg TID Amoxicillin-Clavulanate 875mg/125mg BID Amoxicillin-Clavulanate 2000mg/125mg BID Cefpodoxime 200mg BID Cefuroxime 500mg BID |
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Azithromycin (Zithromax®) Pregnancy: B; Lactation: Unk
Tabs: 250 mg and Z-Pak
Oral Susp: 100 mg/5 mL 200 mg/5 mL
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Children >6 months: 10 mg/kg/day (max 500 mg) once ´ 1 day, then 5 mg/kg/day (max 250 mg) once daily ´ 4 days.
100 mg/5 mL 10 kg (22 lb) = 1 tsp (5 mL) once 1 day, then 1/2 tsp (2.5 mL) daily for days 2-5.
200 mg/5 mL 20 kg (44 lb) = 1 tsp (5 mL) once × 1 day, then 1/2 tsp (2.5 mL) daily for days 2-5.
30 kg (66 lb) = 11/2 tsp (7.5 mL) (2.5 mL) once × 1 day, then 3/4 tsp daily for days 2-5.
Adult: Dispense one Z-Pak.
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Food: Oral suspension should be taken 1 hour before or 2 hours after food. Tablets may be taken without regard to food.
Important side effects: Nausea, diarrhea, elevated LFTs. |
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Clarithromycin (Biaxin, Biaxin XL®) Pregnancy: C; Lactation: Unk
Tabs: 250 mg, 500 mg
Extended Release Tab (XL): 500 mg
Oral Susp: 125 mg/5 mL 250 mg/5 mL |
Children >6 months: 15 mg/kg/day (max 1 g/day) PO in divided doses twice daily for 7-10 days.
125 mg/5 mL 9 kg (20 lb) = 1/2 tsp (2.5 mL) Q12H 17 kg (37 lb) = 1 tsp (5 mL) Q12H
250 mg/5 mL 25 kg (55 lb) = 3/4 tsp Q12H 33 kg (73 lb) = 1 tsp (5 mL) Q12H
Adult: 500 mg PO twice daily or 1g XL once daily for 7-10 days.
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Food: Extended release tablet with food. Others without regard to food.
Important side effects: Nausea, drug interactions. |
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Doxycycline For macrolide allergic patients. Not active vs. Legionella (Vibramycin®) Generics available Pregnancy: D; Lactation: Unsafe
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Adolescents >8 years or Adult: 100 mg PO twice daily for 7-10 days. |
Food: May take with food if GI upset occurs. Take 1 hour before or 2 hours after antacids, iron, milk, or other dairy products. Take with full glass of water to prevent esophagitis. |
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Caps: 50 mg, 100 mg Tabs: 50 mg, 100 mg
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Important side effects: Photosensitivity (use sunscreen), esophagitis. May discolor fingernails . |
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BRONCHOPULMONARY - Pneumonia - Community-acquired Empiric therapy
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Erythromycin estolate or base In nonsmoker; not active vs. H. influenzae. (Ilosone®, E-mycin®, Ery-Tab®) Generics available Pregnancy: B; Lactation: Unsafe
Estolate: Tabs: 500 mg Caps: 250 mg Susp: 125 mg/5 mL and 250 mg/5 mL |
Children: 40 mg/kg/day estolate (max 2 g/day) in two to four divided doses daily for 7-10 days.
125 mg/5 mL @ 40 mg/kg/day 3 kg (7 lb) = 1/2 tsp (2.5 mL) Q12H 6 kg (14 lb) = 1 tsp (5 mL) Q12H 9 kg (21 lb) = 1 tsp (5 mL) Q8H 13 kg (28 lb) = 2 tsp (10 mL) Q12H or 1 tsp (5 mL) PO Q6H |
Food: May take with or without meals. Take with food if causes GI upset.
Important side effects: GI upset, hepatitis.
Note: May cause greater GI upset than newer generation macrolides, such as azithromycin and clarithromycin. |
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Oral Drops: 100 mg/mL 250 mg/5 mL
Base: Tabs: 250 mg, 333 mg, 500 mg Caps: 250 mg 500 mg |
250 mg/5 mL @ 40 mg/kg/day 13 kg (28 lb) = 1 tsp (5 mL) Q12H 19 kg (40 lb) = 1 tsp (5 mL) Q8H 25 kg (55 lb) = 1 tsp (5 mL) Q6H 37 kg (82 lb) = 2 tsp (10 mL) Q8H
Adult: Erythromycin base or estolate 500 mg PO four times daily for 7-10 days.
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Fluoroquinolones: Increased activity vs. above agents against drug-resistant S. pneumoniae. To help avoid developing resistance, consider reserving therapy with these agents to patients who have undergone unsuccessful therapy or are allergic or intolerant to above agents, or have documented drug-resistant S. pneumoniae (Penicillin MIC <4 mg/mL). |
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Levofloxacin (Levaquin®) Pregnancy: C; Lactation: Unsafe
Tabs: 250, 500 mg, 750mg Oral Solu: 25 mg/mL |
Adult: Possible mulit-drugs resistance (MDRSP): 500 mg x 7-14 days Non-MDRSP: 750mg x 5 days |
Food: May take with or without meals. Do not take within 2 hours of antacids, magnesium, calcium supplements, zinc, aluminum, sucralfate, vitamins, or minerals (iron or zinc).
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Important side effects: Photosensitivity, dizziness.
Reduce dose in severe renal disease (CrCl < 50 mL/min).
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Alternatives Beta-lactams not active against atypical organisms. High-dose amoxicillin for suspected pneumococcal pneumonia, but does not reliably cover H. influenzae.
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Amoxicillin (Amoxil®) Generics available
Pregnancy: B; Lactation: Unsafe Caps: 250 mg, 500 mg Tabs: 500 mg, 875 mg Chewable Tabs: 125 mg, 200 mg, 250 mg, 400 mg Suspension: 125 mg/5 mL, 250 mg/5 mL, 400 mg/5 mL Oral drops: 50 mg/mL |
Children: 80-90 mg/kg/day (max 1500 mg/day) in divided doses three times daily for 10-14 days.
250 mg/5 mL at 80 mg/kg/day 8 kg (18 lb) = 1 tsp (5 mL) Q8H 13 kg (29 lb) = 11/2 tsp (7.5 mL) Q8H 17 kg (37 lb) = 2 tsp (10 mL) Q8H 21 kg (46 lb) = 21/2 tsp (12.5 mL) (NTE 500 mg) Q8H 25 kg (55 lb) = 3 tsp (15 mL) (NTE 500 mg) Q8H
Adult: 1 g PO three times daily for 7-10 days.
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Food: May take with or without meals.
Important side effects: Diarrhea and nausea. May cause nonallergic maculopapular rash.
Reduce dose if renal disease (CrCl <30 mL/min). |
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Amoxicillin/clavulanate (Augmentin®) Pregnancy: B; Lactation: Unk
Q12H Formulations:
Tabs: 500 mg/125 mg, 875 mg/125 mg |
Adult: 875 mg/125 mg Q12H × 10-14 days. |
Food: Take with meals to reduce diarrhea.
Side effects: Diarrhea (take with food). May cause nonallergic amoxicillin rash. Nausea, rash.
Use with caution in hepatic disease.
Reduce dose if renal disease (CrCl <30 mL/min).
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Cefpodoxime Vantin® Pregnancy: B; Lactation: Unk Tabs: 100 mg ,200 mg
Granules for Oral Suspension: 50 mg/5 mL , 100 mg/5 mL |
Children ≥ 5 months to 12 years: 10 mg/kg/day in one or two divided doses (max 400 mg/day) for 10-14 days.
50 mg/tsp @ 10 mg/kg/day 10 kg (22 lb) = 1 tsp (5 mL) Q12H or 2 tsp |
Food: Take tablet with food. Suspension may be taken without regard to food.
Important side effects: Nausea, vomiting, rash, diarrhea, elevated LFTs. |
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(10 mL) Q24H 15 kg (33 lb) = 11/2 tsp (7.5 mL) Q12H or 3 tsp (15 mL) Q24H
100 mg/tsp @10 mg/kg/day 15 kg (33 lb) = 3/4 tsp Q12H or 11/2 tsp (7.5 mL) Q24H 20 kg (44 lb) = 1 tsp (5 mL) Q12H 30 kg (66 lb) = 11/2 tsp (7.5 mL) Q12H or 3 tsp (15 mL) Q24H 40 kg (88 lb) = Use adult dose.
≥ 12 years to Adult: 200-400 mg twice daily for 7-14 days.
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Cefuroxime axetil (Ceftin®) Pregnancy: B; Lactation: Unsafe
Tabs: 125 mg, 250 mg, 500 mg
Oral Susp: 125 mg/5 mL, 250 mg/5 mL
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Children >3 months to 12 years: 30 mg/kg/day (max 1 g/day) in divided doses twice daily for 7-14 days.
125 mg/5 mL @ 30 mg/kg/day 8 kg (18 lb) = 1 tsp (5 mL) (5 mL) Q12H 12.5 kg (27 lb) = 11/2 tsp (7.5 mL) Q12H 17 kg (37 lb) = 2 tsp (10 mL) Q12H 25 kg (55 lb) = 3 tsp (15 mL) Q12H 33 kg (73 lb) = Use adult dose.
Children ≥13 years or Adult: 500 mg PO twice daily for 7-10 days.
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Food: Take suspension with food. Tablets may be taken without regard to food.
Important side effects: Nausea, vomiting, rash.
Reduce dose if renal disease (CrCl <30 mL/min). |
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