Treatment of Haemophilus influenzae Pneumonia in Adult Inpatients with Nonsevere Community-Acquired Pneumonia
Clinical Scenario
This protocol addresses adult inpatients admitted with nonsevere community-acquired pneumonia (CAP) due to Haemophilus influenzae, who have no risk factors for MRSA or Pseudomonas aeruginosa — meaning no prior respiratory isolation of either organism and no recent hospitalisation with receipt of parenteral antibiotics within the preceding 90 days.
Adult inpatient
Nonsevere CAP
No MRSA risk factors
No P. aeruginosa risk factors
Clinical Goals
Treatment aims for clinical stability: resolution of vital sign abnormalities (heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature), return of the ability to eat, and normal mentation. Most patients are expected to reach stability within 48 to 72 hours.
Treatment Approach
Empiric antibiotic therapy for this population involves either combination therapy — pairing a b-lactam with a macrolide — or monotherapy with a respiratory fluoroquinolone. An alternative combination approach is defined for patients with contraindications to both macrolide and fluoroquinolone agents. The complete agent selection, full options, and duration criteria are in the structured protocol.
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).
- 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).
- As most patients will achieve clinical stability within the first 48 to 72 hours, a total duration of therapy of 5 days will be appropriate for most patients.
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