©2007 UpToDate®
Table 4. Group III: Inpatients, not in ICU*[Bullet]
Organisms Therapy[Delta]
a. Cardiopulmonary Disease and/or Modifying Factors (including being from a nursing home)

Strep. pneu. (including DRSP)

Hemophilus inf.

Mycoplasma pneu.

Chlamydia pneu.

Mixed infection (bacteria plus atypical pathogen)

Enteric GN

Aspiration (anaerobes)

Viruses

Legionella spp.

Miscellaneous (Mycobacterium TBC, endemic fungi, P. carinii)

IV [Beta]-lactam[Lozenge] (cefotaxime, ceftriaxone, amoxicillin/sulbactam, high-dose ampicillin)

PLUS

IV or oral macrolide or doxycycline§

OR

IV antipneumococcal fluoroquinolone alone

b. No Cardiopulmonary Disease, No Modifying Factors

S. pneumoniae

H. influenzae

M. pneumoniae

C. pneumoniae

Mixed infection (bacteria plus atypical pathogen)

Viruses

Legionella spp.

Miscellaneous (M. tuberculosis, endemic fungi, P. carinii)

IV azithromycin alone (If macrolide allergic or intolerant: Doxycyline and a [Beta]-lactam)

OR

Monotherapy with an antipneumococcal fluoroquinolone

* Excludes patients at risk for HIV.
[Bullet] In roughly one-third to one-half of the cases no etiology was identified.
[Delta] In no particular order.
[Lozenge] Antipseudomonal agents such as cefepime, piperacillin/tazobactam, imipenem, and meropenem are generally active against DRSP, but not recommended for routine use in this population that does not have risk factors for P. aeruginosa.
§ Use of doxycyline or an advanced generation macrolide (azithromycin or clarithromycin) will provide adequate coverage if the selected [Beta]-lactam is susceptible to bacterial B-lactamases (see text).

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