Recommended treatment for pneumonia
| Setting | Patients with risk factors for resistant gram-negative organisms | Patients without risk factors |
|---|---|---|
| Outpatient | A respiratory fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin), or A beta-lactam (high-dose amoxicillin or amoxicillin-clavulanate, or ceftriaxone, cefpodoxime, cefuroxime) plus a macrolide (azithromycin, clarithromycin, or erythromycin) Doxycycline can be an alternative to a macrolide | A macrolide (azithromycin, clarithromycin, or erythromycin), or Doxycycline, or Amoxicillin |
| Inpatient, not in intensive care | An antipneumococcal, antipseudomonal beta-lactam (eg, piperacillin-tazobactam) plus either ciprofloxacin or levofloxacin, or An antipneumococcal, antipseudomonal beta-lactam plus an aminoglycoside and azithromycin, or An antipneumococcal, antipseudomonal beta-lactam plus an aminoglycoside and an antipneumococcal fluoroquinolone For penicillin-allergic patients, substitute aztreonam for the beta-lactam | A respiratory fluoroquinolone, or A beta-lactam (cefotaxime, ceftriaxone, ampicillin, or ertapenem) plus a macrolide Doxycycline can be an alternative to macrolide A respiratory fluoroquinolone should be used for penicillin-allergic patients |
| Intensive care | An antipneumococcal, antipseudomonal beta- lactam plus either ciprofloxacin or levofloxacin, or An antipneumococcal, antipseudomonal beta-lactam plus an aminoglycoside and azithromycin, or An antipneumococcal, antipseudomonal beta-lactam plus an aminoglycoside and an antipneumococcal fluoroquinolone For penicillin-allergic patients, substitute aztreonam for the beta-lactam | A beta-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) plus either azithromycin or a fluoroquinolone For penicillin-allergic patients, a respiratory fluoroquinolone and aztreonam |
Based on information in references 1, 27, and 28.