Clinical definition:
Severe disease is defined as CURB-65 score greater than two and requires hospitalization.
| Preferred antibiotic choice(s) | |||
| Drug | Formulation | Dosage | Duration |
| Combination therapy with: Ceftriaxone (IV/IM) OR Cefotaxime (IV/IM) PLUS Clarithromycin OR Azithromycin (PO) | Ceftriaxone- Powder for injection: 250 mg; 1 g (as sodium salt) in vial | 2 g daily | 5 days |
| Cefotaxime – Powder for injection: 250 mg per vial (as sodium salt | 2 g 8 hourly | 5 days | |
| Clarithromycin- Solid oral dosage form: 500 mg; Powder for oral liquid: 125 mg/5 mL; 250 mg/5 mL; Powder for injection: 500 mg in vial | 500 mg by mouth 12 hourly | 5 days | |
| Azithromycin- Capsule: 250 mg; 500 mg (anhydrous); Oral liquid: 200 mg/5 mL | 500 mg daily | 5 days | |
| In case of confirmed drug allergy or medical contraindication | |||
| Moxifloxacin (IV/PO) | Tablet: 400 mg; Tablet (dispersible): 100 mg; Injectable solution: 400mg/250 mL3 | 400 mg daily | 5 days |
Principles of Stewardship:
- Obtain a blood culture prior to starting antibiotic therapy.
- If available, perform a legionella urinary antigen test – a positive result will allow stopping of the b-lactam and extension of azithromycin to a minimum of 7 days to treat pneumophilia
- In high TB-endemic areas, assess patients presenting with fever and cough with or without constitutional symptoms (anorexia, weight loss, night sweats) for active TB disease.
- Doxycycline may be used in place of a macrolide if unavailable.