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Table 1 Empirical antibiotic therapy scheme for Community Acquired Pneumonia in the main international guidelines

From: Antibiotic therapy, supportive treatment and management of immunomodulation-inflammation response in community acquired pneumonia: review of recommendations

  Outpatients Inpatients ICU-patients
ICDS/ATS 2007 Guideline Previously
Respiratory Fluoroquinolones Or β-Lactam plus macrolide No pseudomonas risk factors Β-Lactam (Cefotaxime, ceftriaxone or ampicillin-sulbactam) plus azithromycin or Respiratory fluoroquinolones.
For penicillin-allergic patients, a respiratory fluoroquinolones and aztreonam.
Comorbidities Fluoroquinolones or βLactam plus macrolide Risk factor for P aeruginosa Antipneumococcal, antipseudomonal β lactam (piperacillin-tazobactam, cefepime, imipenem or meropenem) plus ciprofloxacin or levofloxacin (750 mg) Or plus aminoglycoside and azithroycin
BTS 2009 (Update NICE 2015) Amoxicillin 500 mg TID
Clarithromycin (Alternative if Hypersensitive)
Amoxicillin and Macrolide OR Macrolide (Alternative if Hypersensitive) OR Doxycicline OR Levofloxacin or moxifloxacin Broad spectrum β lactamase antibiotic plus macrolide
Second or third generation cephalosporin, if hypersensitivity to β lactam, plus clarithromycin
ERS/ESCMI 2011 Amoxicillin or Tetracycline
Tetracycline or macrolide Alternative
Levofloxacin or moxifloxacin (Alternative if hypersensitivity in countries with high incidence of macrolide resistant pneumococcus)
Aminopenicillin plus macrolide
Aminopenicillin/β lactamase inhibitor plus macrolide
Non antipseudomonas cephalosporin plus macrolide
Penicillin G plus macrolide
No pseudomonas risk factors Non antipseudomonal cephalosporin III plus macrolide Or Moxifloxacine or levofloxacin plus non antipseudomonas cephalosporin III
Risk factor for P aeruginosa Antipseudomonal cephalosporin or acylureidopenicillin/βlactamase inhibitor or CarbapenemPlus Ciprofloxacin or Plus Macrolide plus Aminoglycoside
  1. ICDS, Infectious Diseases Society of America; ATS American Thoracic Society, BTS British Thoracic Society, NICE National Institute for Health and Care Excellence, ERS European Respiratory Society, ESCMI European Society for Clinical Microbiology and Infectious Disease