Pulmonary Infections

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

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Aspiration Pneumonia