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Infection/Condition and Likely Organism |
Suggested treatment |
Comments
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Preferred |
Alternative |
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Pneumonia of low severity With CURB-65 score 0-1 Causative organism Streptococcus pneumoniae Haemophilus influenzae Mycoplasma pneumoniae |
Amoxicillin 500mg PO q8h for 5-7 days
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Penicillin allergy or if atypical pathogens suspected Doxycycline 200mg on first day, then 100mg PO q24h for 4 days (total 5 days course) OR Clarithromycin 500mg q12h for 5 days OR Erythromycin (in pregnant) 500mg q6h for 5 days |
CURB-65 is a clinical prediction rule that has been validated for grading severity and predicting mortality in CAP. One point each is given for
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Pneumonia of moderate severity With CURB-65 score 2 Causative organism Streptococcus pneumoniae Haemophilus influenzae Chlamydia pneumoniae |
Amoxicillin 500mg PO q8h for 5-7 days PLUS Clarithromycin 500mg PO q12h for 5 days OR Erythromycin (in pregnant) 500mg PO q6h for 5 days |
Penicillin allergy Doxycycline 200mg on first day, then 100mg PO q24h for 4 days (total 5 days course) OR Clarithromycin 500mg q12h for 5 days |
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Pneumonia of high severity With CURB-65 score 3-5 Causative organism Streptococcus pneumoniae Staphylococcus aureus Legionella spp. |
Amoxicillin-clavulanate 1.2gm IV q8h for 5-7 days PLUS Clarithromycin 500mg PO or IV q12h for 5 days OR Erythromycin (in pregnant) 500mg PO q6h for 5 days |
Levofloxacin 500-750mg PO or IV q24h for 5 days |
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RESPIRATORY TRACT INFECTIONS
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Infection/Condition and Likely Organism |
Suggested treatment |
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COVID-19
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Remdesivir 200mg IV once then 100mg IV once a day for 4 days or until hospital discharge (may extend to 10 days)
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For symptomatic patients with hypoxemia in early viremic phase. |
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Influenza
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Oseltamivir 75mg PO q12h for 5 days |
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Varicella zoster
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Acyclovir 10mg/kg IV q8h for 7 days |
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***If MRSA is common nosocomial pathogen in the institution (>10-20% local prevalence) – empirically cover for MRSA in VAP
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Infection/Condition and Likely Organism |
Suggested treatment |
Comments
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Preferred |
Alternative |
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Early Onset HAP/VAP AND No associated risk for MDR (5 days of admission/ intubation) |
Amoxicillin-clavulanate 1.2 gm IV q8h for 5-7 days |
Ceftriaxone 2gm IV q24h for 5-7 days |
Risk factors for multidrug resistant (MDR) organisms: 1. Prior IV antibiotic use within 90 days. 2. > 5 days of hospitalization in ICU/ HDU. 3. Previous colonization with MDR pathogens Risk of MDR organisms is lower with early onset HAP/VAP. |
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Late Onset HAP/VAP (5 days or more of admission/intubation) |
Piperacillin-tazobactam 4.5gm IV q6-8h for 7 days OR Cefepime 2gm IV q8h for 7 days |
Imipenem-cilastatin 500mg IV q6h for 7 days OR Meropenem 1gm IV q8h for 7 days
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Duration - 7 days. |
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Infection/Condition and Likely Organism |
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Comments |
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Preferred |
Alternative |
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Causative organisms Streptococcus pneumoniae Staphylococcus aureus Haemophilus influenzae Pseudomonas aeruginosa
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Amoxicillin-clavulanate 1.2gm IV q8h
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Ceftriaxone 2gm IV q24h PLUS *Metronidazole 500mg IV q8h OR Azithromycin 500mg q24h for 5 days OR Clarithromycin 500mg q12h for 5 days
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Duration: 7-10 days *In those with poor dental hygiene Antibiotics – not indicated for chemical pneumonitis. |
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Infection/Condition and Likely Organism |
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Preferred |
Alternative |
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Outpatient Causative organism Streptococcus pneumoniae |
Amoxicillin-clavulanate 625mg PO q8h for 5-7 days |
Doxycycline 100mg PO q12h for 5-7 days OR Cefuroxime 500mg PO q12h for 5-7 days |
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Inpatient Causative organisms Streptococcus pneumoniae Pseudomonas aeruginosa **Suspect Pseudomonas infection if:
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Amoxicillin-clavulanate 1.2gm IV q8h for 5-7 days PLUS* Azithromycin 500mg IV/ PO for 3-5 days |
Ceftriaxone 2gm IV q24h for 5-7days PLUS* Azithromycin 500mg IV/PO for 3-5 days |
*If atypical pneumonia |
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Piperacillin-tazobactam 4.5gm IV q6-8h OR Cefepime 2gm IV q8h PLUS Azithromycin 500mg IV/ PO for 3-5 days |
Ceftazidime 2gm IV q8h PLUS Azithromycin 500mg IV/PO for 3-5 days |
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Infection/Condition and Likely Organism |
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Preferred |
Alternative |
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Empirical |
Amoxicillin-clavulanate 1.2gm IV q6-8h |
Ceftriaxone 2gm IV q24h PLUS *Metronidazole 500mg IV q8h Penicillin allergy Clindamycin 600mg IV/PO q6h |
In empyema drain the collection wherever feasible. Duration of treatment: After drainage : 2-4 weeks Undrained : 4-6 weeks *Metronidazole: in cases of lung abscess when aspiration is suspected. |
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Causative organism Staphylococcus aureus |
Cloxacillin 2gm IV q4-6h |
Cefazolin 2gm IV q8h |
Duration 4-6 weeks, depending on clinical response. In case of slow response, may have to be prolonged. May change to oral therapy (e.g. Amoxicillin-clavulanate 625mg PO q8h) to complete the duration once patient stabilized and improved. |