University of Pennsylvania Medical Center Guidelines for Antibiotic Use

Pulmonary Infections Other than Community Acquired Pneumonia

 

Clinical Setting

Empiric Treatment

Likely Pathogens

Definitive Treatment

Dosage Regimen

Duration

Aspiration Pneumonia

Outpatient acquired

penicillin G1 + metronidazole

oral flora

penicillin G +

metronidazole

3.0 mu IV q 4 hr

500mg IV/PO q 12 hr

10-14 days3

Nosocomial (includes nursing home2)

cefepime

OR

piperacillin/tazobactam4

oral flora

cefepime

 

1 gm IV q 12 hr

10-14 days3 

Enterobacteriaceae

TMP/SMX + 

metronidazole

8-10mg/kg/d TMP in 3-4 divided doses

500mg IV/PO q 12 hr

P. aeruginosa

review susceptibility data

S. aureus

nafcillin5 or

cefazolin5

2gm IV q 4-6 hr

500mg IV q 8 hr

A. baumanii

review susceptibility data

Tracheobronchitis

Acute

TMP/SMX

S. pneumoniae

amoxicillin6

1gm PO q 12 hr

10-14 days

 

H. influenzae

M. catarrhalis

TMP/SMX

160mg/800mg (1 double strength tablet) PO BID

Mycoplasma spp.

erythromycin base

500mg PO q 6 hr

Chlamydia pneumoniae

doxycycline OR

 erythromycin base

100mg PO q 12 hr

500mg PO q 6 hr

viral

no treatment

Intubation/Tracheostomy

TMP/SMX7

S. aureus

nafcillin5 OR

cefazolin5

2 gm IV q 4-6 hr

500mg IV q 8 hr

14 days

 

Enterobacteriaceae

TMP/SMX

8-10mg/kg/d TMP IV in 3-4 divided doses

P. aeruginosa

cefepime8

2gm IV q 12 hr

A. baumanii

review susceptibility data8

 

1If penicillin allergy use clindamycin

2If community-acquired pneumonia is a possibility add azithromycin to regimen

3Can switch to oral therapy once clinical improvement occurs: for penicillin G - use amoxicillin 1 gm poTID

4For piperacillin/tazobactam dosing, please refer to the renal dosing guidelines for recommendations. 

5If penicillin allergy use clindamycin or trimethoprim/sulfamethoxazole; if MRSA-use vancomycin

6Review susceptibilities-S. pneumoniae resistance ranges from 4-7% (NCCLS criteria)

7Substitute levofloxacin if gram negative bacilli are seen on Gram stain or if P. aeruginosa suspected.

8If multiresistant microorganism, consider aerosolized tobramycin

updated 9/28/04 by Lori LaRosa

Back to Table of Contents