Empiric Antibiotics Regimens for Common Infections

Empiric Antibiotics Regimens for Common Infections

Infection	Common Pathogens	Patient/Infection                Factors	Initial    Empiric Therapy Options
Community acquired pneumonia	Streptococcus pneumoniae Haemophilus influenzae Mycoplasma pneumoniae Chlamydophila pneumoniae Legionella pneumophila	Outpatient,        otherwise                healthy, no                recent   antibiotic                exposure	Doxycycline        or                Azithromycin or                Clarithromycin
		Outpatient,                comorbidities and/or  recent   antibiotic exposure	Amoxicillin          or Amoxicillin/Clavulanate or Cefuroxime -Plus- Azithromycin     or Clarithromycin -OR- Levofloxacin       or                Moxifloxacin or                Gemifloxacin
		Inpatient,            non-ICU	Ceftriaxone        or                Cefotaxime        or Ampicillin             or                Ertapenem -Plus- Azithromycin     or Clarithromycin   or                Doxycycline -OR- Levofloxacin       or                Moxifloxacin
		Inpatient,            ICU	Ceftriaxone        or                Cefotaxime        or Ampicillin/Sulbactam -Plus- Azithromycin     or                Levofloxacin or                Moxifloxacin

Healthcare associated pneumonia	Streptococcus pneumoniae Haemophilus influenzae Staphylococcus aureus  (MSSA) Escherichia                coli Klebsiella pnueumoniae	Early-onset         (within  5                days       of hospitalization) and                no           recent antibiotic             exposure	Ceftriaxone        or Ampicillin/Sulbactam      or Ertapenem         or                Levofloxacin       or Moxifloxacin
	As           above                plus: Staphylococcus aureus  (MRSA) Enterobacter species Proteus species Serratia species Pseudomonas aeruginosa	Late-onset          (after    5                days       of hospitalization) and/or                recent antibiotic                exposure	Cefepime            or                Ceftazidime        or Imipenem           or                Meropenem      or Piperacillin/Tazobactam or Aztreonam -Plus- Ciprofloxacin      or                Levofloxacin or                Gentamicin         or                Tobramycin or                Amikacin -Plus- Vancomycin       or                Linezolid
Otitis   media	Viruses Streptococcus pneumoniae Haemophilus influenzae Moraxaella catarrhalis	Mild-moderate otalgia                with temperature                ≤             39°C	Amoxicillin          or                Cefuroxime        or Cefpodoxime     or                Azithromycin
		Severe  otalgia   and/or temperature      ≥                39°C	Amoxicillin/Clavulanate or Ceftriaxone
Pharyngitis	Viruses Streptococcus pyogenes	Documented     or                high       risk         for Streptococcus    pyogenes	Penicillin              VK          or                Cephalexin         or Azithromycin
Urinary tract infections	Escherichia                coli Proteus species Klebsiella pneumoniae Staphylococcus	Uncomplicated                communityacquired             lower    urinary                tract infection   in                healthy women,                < 50           years     old	TMP/SMX           or                Nitrofurantoin   or Fosfomycin         or Ciprofloxacin      or                Levofloxacin

	saphrophyticus Enterococcus species
		Community-acquired complicated       urinary                tract infection   or                pyelonephritis	Ciprofloxacin      or                Levofloxacin or                Ceftriaxone        or                Ertapenem
	As           above                plus: Enterobacter species Pseudomonas aeruginosa	Nosocomial        complicated urinary  tract       infection                or pyelonephritis	Ceftazidime        or Piperacillin/Tazobactam or Cefepime            or                Meropenem      or Imipenem
Skin/soft tissue infections	Streptococcus pyogenes Staphylococcus aureus	Low        risk         for          MRSA	Cefazolin             or                Nafcillin                or Cephalexin         or                Dicloxacillin
		High       risk         for          MRSA	Vancomycin       or                Linezolid              or Clindamycin -OR- Cephalexin         or                Dicloxacillin -Plus- Doxycycline        or                TMP/SMX
	As           above                plus: Escherichia                coli Proteus species Klebsiella pneumoniae Bacteroides fragilis Enterococcus species Pseudomonas aeruginosa	Diabetic                foot                infection, moderate                to            severe	Ceftriaxone        or Ampicillin/Sulbactam      or Piperacillin/Tazobactam or Ertapenem -OR- Levofloxacin       or                Ciprofloxacin -Plus- Clindamycin All           WITH     or                WITHOUT Vancomycin
Intra- abdominal infections	Escherichia                coli Proteus species Klebsiella	Community-acquired,                mildmoderate                severity	Ertapenem         or                Moxifloxacin      or Tigecycline -OR- Cefazolin             or                Ceftriaxone        or

	pneumoniae Bacteroides fragilis Enterococcus species viridans Streptococcus		Levofloxacin       or                Ciprofloxacin -Plus- Metronidazole
	As           above                plus: Pseudomonas aeruginosa Enterobacter spp Serratia spp	Community-acquired,                high severity                or            high-risk                patient -OR- Nosocomial        (any                severity or patient)	Piperacillin/Tazobactam or Imipenem           or                Meropenem -OR- Ceftazidime        or                Cefepime -Plus- Metronidazole All           WITH     or                WITHOUT Vancomycin
Community acquired meningitis	Streptococcus pneumoniae Neisseria meningitidis	Otherwise           healthy,                2–50      years of                age	Ceftriaxone -Plus- Vancomycin
	As           above                plus: Listeria monocytogenes	>             50           years                of            age                or immunocompromised	Ceftriaxone -Plus- Vancomycin -PlusAmpicillin
Healthcare associated infectious diarrhea	Clostridium difficile	Mild-moderate infection	Metronidazole  (oral)
		Severe  infection	Vancomycin       (oral)     or Fidaxomicin
		Severe, complicated                infection (e.g.,     ileus)	Vancomycin       (oral) -Plus- Intravenous                metronidazole
Community acquired infectious	Shigella Salmonella Escherichia                coli	See        above	Fluoroquinolone              or                TMP/SMX if             antibiotic                therapy is necessary

diarrhea

Campylobacter Clostridium difficile (uncommon)