علاج الالتهاب الرئوي البكتيري الآخر في البالغين المقبولين بالتهاب رئوي مكتسب من المجتمع غير حاد

References

DOI: 10.1164/rccm.201908-1581ST

• In inpatient adults with nonsevere CAP without risk factors for MRSA or P. aeruginosa (see Recommendation 11), we recommend the following empiric treatment regimens (in no order of preference) (Table 4):
• combination therapy with a b-lactam (ampicillin + sulbactam 1.5–3 g every 6 h, cefotaxime 1–2 g every 8 h, ceftriaxone 1–2 g daily, or ceftaroline 600 mg every 12 h) and a macrolide (azithromycin 500 mg daily or clarithromycin 500 mg twice daily) (strong recommendation, high quality of evidence), or
• monotherapy with a respiratory fluoroquinolone (levofloxacin 750 mg daily, moxifloxacin 400 mg daily) (strong recommendation, high quality of evidence).
• A third option for adults with CAP who have contraindications to both macrolides and fluoroquinolones is:
• combination therapy with a b-lactam (ampicillin + sulbactam, cefotaxime, ceftaroline, or ceftriaxone, doses as above) and doxycycline 100 mg twice daily (conditional recommendation, low quality of evidence).
• Risk factors include prior respiratory isolation of MRSA or P. aeruginosa or recent hospitalization AND receipt of parenteral antibiotics (in the last 90 d).
• We recommend that the duration of antibiotic therapy should be guided by a validated measure of clinical stability (resolution of vital sign abnormalities [heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature], ability to eat, and normal mentation), and antibiotic therapy should be continued until the patient achieves stability and for no less than a total of 5 days (strong recommendation, moderate quality of evidence).