Sandbox Rim: Difference between revisions
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|colspan=2|Outpatient | |||
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|Previously healthy and no use of antimicrobials within the previous 3 months || A macrolide <br> Doxycyline | |||
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|Presence of comorbidities such as chronic heart, lung, liver or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressing conditions or use of immunosuppressing drugs||A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg])<br> | |||
A b-lactam plus a macrolide | |||
|- | |||
|Use of antimicrobials within the last 3 months|| An alternative from a different class should be selected:<br> | |||
A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg]) (strong recommendation; level I evidence)<br> | |||
A b-lactam plus a macrolide (strong recommendation; level I evidence) | |||
|- | |||
|In regions with a high rate (125%) of infection with high-level (MIC 16 mg/mL) macrolide-resistant Streptococcus pneumoniae||A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg])<br> | |||
A b-lactam plus a macrolide | |||
|- | |||
|Inpatient general medical ward || A respiratory fluoroquinolone<br>A b-lactam plus a macrolide | |||
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| Inpatient ICU || A b-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) plus azithromycin<br> A b-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) plus a fluoroquinolone | |||
<br> For penicillin-allergic patients: a respiratory fluoroquinolone and aztreonam | |||
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|Concern about pseudomonas||An antipneumococcal, antipseudomonal b-lactam (piperacillintazobactam, cefepime, imipenem, or meropenem) plus either ciprofloxacin or levofloxacin (750 mg) | |||
<br> B-lactam plus an aminoglycoside and azithromycin | |||
<br>B-lactam plus an aminoglycoside and an antipneumococcal fluoroquinolone<br> | |||
For penicillin-allergic patients, substitute aztreonam for above b-lactam | |||
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|Concern about community acquired MRSA || Add vancomycin or linezolid | |||
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Revision as of 19:21, 19 February 2015
| Outpatient | ||
| Previously healthy and no use of antimicrobials within the previous 3 months | A macrolide Doxycyline | |
| Presence of comorbidities such as chronic heart, lung, liver or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressing conditions or use of immunosuppressing drugs | A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg]) A b-lactam plus a macrolide | |
| Use of antimicrobials within the last 3 months | An alternative from a different class should be selected: A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg]) (strong recommendation; level I evidence) | |
| In regions with a high rate (125%) of infection with high-level (MIC 16 mg/mL) macrolide-resistant Streptococcus pneumoniae | A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg]) A b-lactam plus a macrolide | |
| Inpatient general medical ward | A respiratory fluoroquinolone A b-lactam plus a macrolide |
|
| Inpatient ICU | A b-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) plus azithromycin A b-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) plus a fluoroquinolone
| |
| Concern about pseudomonas | An antipneumococcal, antipseudomonal b-lactam (piperacillintazobactam, cefepime, imipenem, or meropenem) plus either ciprofloxacin or levofloxacin (750 mg)
| |
| Concern about community acquired MRSA | Add vancomycin or linezolid | |