Severe disease is defined as CURB-65 score greater than two and requires hospitalization.
|Preferred antibiotic choice(s)|
|Combination therapy with:
|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
|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.