Version May 2024
While methicillin-susceptible Staphylococcus aureus, beta-lactamase producing Haemophilus influenzae, Moraxella catarrhalis, and certain Gram-negative bacilli also cause CAP in the outpatient setting, they tend to occur more frequently in older patients and those with comorbidities or recent antibiotic use; these pathogens are less common in younger, otherwise healthy patients.
Modifications to this treatment algorithm may be needed for patients with a history of infection with drug-resistant pathogens or potential exposure to other pathogens.CAP: community-acquired pneumonia.
* Serious comorbidities include, but are not limited to, chronic heart, renal, or liver disease, diabetes mellitus, asplenia, and immunosuppression.
¶ Patients with mild non-IgE-mediated reactions (eg, maculopapular rash) to penicillin or known cephalosporin tolerance can generally use later-generation cephalosporins safely. Patients with IgE-mediated reactions (hives, angioedema, anaphylaxis) or severe delayed reactions should generally use other agents. Refer to the UpToDate text on penicillin hypersensitivity reactions for detail.
Δ Amoxicillin-clavulanate covers a broader spectrum of pathogens than amoxicillin (eg, some strains of penicillin-resistant S. pneumoniae, beta-lactamase-producing Haemophlius influenzae); these pathogens are tend to occur in older patients and those with comorbidities or with recent antibiotic use and are less common in younger, otherwise healthy pregnant patients with CAP. In the absence of comorbidities or other predisposing factors, we select between them based on patient preference (eg, for thrice or twice daily dosing, narrower versus broader antibiotic).
◊ Although azithromycin has a good safety profile, clarithromycin has produced adverse pregnancy outcomes and is thus avoided in pregnant patients.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
