Update of Practice Guidelines for the Management of Community-Acquired Pneumonia in Immunocompetent Adults

Recent antibiotic therapy b A respiratory fluoroquinolone c alone, an advanced macrolide d plus high-dose amoxicillin, e or an advanced macrolide plus high-dose amoxicillin-clavulanate f Comorbidities (COPD, diabetes, renal or congestive heart failure, or malignancy) No recent antibiotic therapy An advanced macrolide d or a respiratory fluoroquinolone Recent antibiotic therapy A respiratory fluoroquinolone c alone or an advanced macrolide plus a b-lactam g Suspected aspiration with infection Amoxicillin-clavulanate or clindamycin Influenza with bacterial superinfection A b-lactam g or a respiratory fluoroquinolone Inpatient Medical ward No recent antibiotic therapy A respiratory fluoroquinolone alone or an advanced macrolide plus a b-lactam h Recent antibiotic therapy An advanced macrolide plus a b-lactam or a respiratory fluoroquinolone alone (regimen selected will depend on nature of recent antibiotic therapy) ICU Pseudomonas infection is not an issue A b-lactam h plus either an advanced macrolide or a respiratory fluoroquinolone Pseudomonas infection is not an issue but patient has a b-lactam allergy A respiratory fluoroquinolone, with or without clindamycin Pseudomonas infection is an issue i Either (1) an antipseudomonal agent j plus ciprofloxacin, or (2) an antipseudomonal agent plus an aminoglycoside k plus a respiratory fluoroquinolone or a macrolide Pseudomonas infection is an issue but the patient has a b-lactam allergy Either (1) aztreonam plus levofloxacin, l or (2) aztreonam plus moxifloxacin or gatifloxacin, with or without an aminoglycoside Nursing home Receiving treatment in nursing home A respiratory fluoroquinolone alone or amoxicillin-clavulanate plus an advanced macrolide Hospitalized Same as for medical ward and ICU NOTE. COPD, chronic obstructive pulmonary disease; ICU, intensive care unit. a Erythromycin, azithromycin, or clarithromycin.