Inpatient Therapy Regimen A

(Note two or three drug therapy) Cefotaxime (Claforan) 2 g IV q8h [B] OR Ceftriaxone (Rocephin) 2 g IV qd [B] PLUS

Erythromycin 5 mg/kg/dose IV qid (max 1 g/dose) [B, except estolate contraindicated] OR

Azithromycin (Zithromax) 500 mg IV qd [B]

PLUS/MINUS (if suspect drug-resistant Strep. pneumoniae)

Vancomycin (Vancocin) 15 mg/kg IV q6h (max 1 g/dose; monitor serum levels) [C]

Regimen B (Note one or two drug therapy) Levofloxacin (Levaquin) 500 mg IV qd [C] PLUS/MINUS (if aspiration suspected) Clindamycin 600 mg IV q8h [B] OUTPATIENT THERAPY Notes:

1. Initial antibiotic selection may differ in areas with community-wide erythromycin (macrolide) resistant S. pneumoniae.

2. Erythromycin variably effective against H. influenzae.

3. Consider initiating outpatient therapy with a single dose of the parenteral antibiotics listed above for inpatient therapy.

1. Azithromycin (Zithromax) 500 mg PO initial dose, then 250 mg PO qd for 4 days [B]

2. Clarithromycin (Biaxin) 250-500 mg PO bid [C]

3. Erythromycin 500 mg PO qid OR erythromycin ethylsuccinate (EES) 400 mg PO bid [B, except estolate contraindicated]

4. Levofloxacin (Levaquin) 500 mg PO qd [C]

5. Doxycycline (Vibramycin) 100 mg PO bid [D]

Course: 10-14 days (except azithromycin as noted) (levofloxacin preferred in areas with S. pneumoniae macrolide resistance) Organisms: S. pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae (TWAR), Legionella sp., H. influenzae

D. ADULTS (OLDER THAN 60 YEARS OF AGE, SMOKER, CHRONIC ILLNESS, ALCOHOLIC) INPATIENT THERAPY

Note: Treat as for adults (60 years old, community acquired, no comorbidity), above. OUTPATIENT THERAPY

Note: Consider initiating outpatient therapy with a single dose of the parenteral antibiotics listed above for inpatient therapy. Regimen A

Azithromycin (Zithromax) 500 mg PO initial dose then 250 mg PO qd for 4 days [B] Clarithromycin (Biaxin) 250-500 mg PO bid [C]

Regimen B (if suspect Drug Resistant S. pneumoniae) Levofloxacin (Levaquin) 500 mg PO qd [C]

Sparfloxacin (Zagam) 400 mg PO initial dose, then 200 mg PO qd [C] Grepafloxacin (Raxar) 600 mg PO qd [C]

Regimen C (if suspect aspiration) Amoxicillin/clavulanate (Augmentin) 500 mg PO tid [B] Course: 10-14 days (except azithromycin as noted)

Organisms: S. pneumoniae, H. influenzae, M. catarrhalis, Legionella sp., Chlamydia pneumoniae, coliforms Pulmonary Tuberculosis

(Chest x-ray positive, active disease) Many regional variations and conflicting recommendations exist. Unless local/regional sensitivities are well established, consider initiating treatment with four drug therapy.

A. CHILDREN Notes:

1. Patients with positive chest x-rays (active disease) must be isolated.

2. All cases must be reported to the local health department.

3. Antituberculosis medications have inherent toxicities and side effects: INH (hepatitis, peripheral neuropathy), rifampin (hepatotoxicity, flu-like syndrome, discoloration of body fluids/staining of contact lenses), PZA (arthralgias, hyperuricemia, hepatitis), ethambutol (optic neuritis), and streptomycin (ototoxicity). Close monitoring is essential.

4. Consider adding pyridoxine (vitamin B6) 25-50 mg PO qd [A] to decrease NIH-induced neuropathy. Isoniazid (INH) 10-20 mg/kg/day PO (max 300 mg/day) [C]

Sleep Apnea

Sleep Apnea

Have You Been Told Over And Over Again That You Snore A Lot, But You Choose To Ignore It? Have you been experiencing lack of sleep at night and find yourself waking up in the wee hours of the morning to find yourself gasping for air?

Get My Free Ebook


Post a comment