Pneumonia, Community-Acquired-Adults (Bacterial, Chlamydia, Legionella, and Mycoplasma)
First Line Drugs
- ERYTHROMYCIN (V07AV)
- APO SULFATRIM TAB (J01EE01)
- PEN-VEE SUSPENSION 300 MG (J01CE10)
Second Line Drugs
- APO TETRA CAP 250MG (J01AA07)
- CIPROFLOXACIN-500 (J01MA02)
Reference
Comments/Instructions
1. Previously well, under 65 years old or both
erythromycin base
1 g/day, divided bid to qidx 10 days
$1.81/10 days
or clarithromycin
250 mg, bid x 10 days
$29.58/10 days
or azithromycin
500 mg, once on first day, then 250 mg, once daily x 4 days
$29.60/5 days
2. Comorbid illness, over 65 years old or both
trimethoprim/ sulfamethoxazole
160 mg/800 mg tablet, bidx 10 days
$2.44/10 days
or amoxicillin/clavulanate
500 mg/125 mg tablet, tidx 10 days
$40.80/10 days
or cefuroxime axetil
500 mg, bid x 10 days
$57.35/10 days
AND, if Legionella is suspected, to any of the above add 1 of the following
erythromycin base
1 g/day, divided bid to qidx 3 weeks
$3.81/3 weeks
or azithromycin
500 mg, once on first day, then 250 mg, once daily x 4 days
$29.60/5 days
or clarithromycin
250 mg, bid x 3 weeks
$62.12/3 weeks
3. For proven Streptococcus pneumoniae in all patients
penicillin V
300 mg, qid x 10 days
$1.58/10 days
Second-line therapies:
1. Previously well, under 65 years old or both
tetracycline
250-500 mg, qid x 10 days
$0.76-1.52/10 days
2. If Legionella is suspected and patient is intolerant of macrolides
ciprofloxacin
500 mg, bid x 3 weeks
$105.24/3 weeks
Additional instructions and notes
-There is no difference in efficacy between the 3 first-line agents listed for pneumonia with comorbid illness, over 65 years old or both (trimethoprim/sulfamethoxazole, cefuroxime axetil and amoxicillin/clavulanate), but there is a major difference in price.
-One observational study did not find any improvement in medical outcomes in patients with comorbid illness, over 65 years old or both who received 1 of the 3 first-line agents compared with those who did not. On average, the cost of therapy for those receiving 1 of the first-line agents was 10 times greater than for those receiving another antibiotic.
-Duration of treatment is arbitrary but common guidelines are: bacterial pneumonias 10 days (except if using azithromycin); Mycoplasma and Chlamydia 14 days; Legionella 21 days (except if using azithromycin).
-Clinically, bacterial and atypical pneumonias cannot be readily distinguished.
-Most untreated Mycoplasma infections resolve in 2 weeks, although radiographic abnormalities persist for months. Antibiotic therapy can reduce the severity and duration of symptoms and fever, but cannot prevent the development of extrapulmonary complications.
-Rates of Streptococcus pneumoniae resistance to penicillin as high as 15-30% have been reported.
-There have been no randomized clinical trials for Chlamydia pneumonia therapy; however, erythromycin failure has been reported.
-Ciprofloxacin is not indicated for the treatment of uncomplicated community-acquired pneumonia unless Legionella is suspected and the patient is unable to tolerate a macrolide (erythromycin, clarithromycin, azithromycin).
-Consider pneumococcal vaccine as prophylaxis for susceptible, high-risk patients.
-There is no clinical difference between tetracycline and doxycycline. Doxycycline may be taken twice daily, but at greater expense.
-Other erythromycins, including modified-release preparations, may be 2-7 times more expensive than erythromycin base.
Tags
- Respiratory System
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