Antibiotic Treatment Guidelines for Pneumonia and Urinary Tract Infections

Pneumonia Treatment

• The Infectious Diseases Society of America recommends using one of the following antibiotics for patients with hospital-acquired pneumonia who are not at high risk of mortality and have no MRSA risk factors: Piperacillin-tazobactam 4.5 g IV q6h, Levofloxacin 750 mg IV daily, Imipenem 500 mg IV q6h, or Meropenem 1 g IV q8h 1, 2, 3
• For patients with hospital-acquired pneumonia who are not at high risk of mortality but have MRSA risk factors, the Infectious Diseases Society of America recommends using one of the above options plus MRSA coverage 1, 2
• For patients with hospital-acquired pneumonia who are at high risk of mortality or have recent antibiotic use, the Infectious Diseases Society of America recommends using two of the following antibiotics: Piperacillin-tazobactam 4.5 g IV q6h, Cefepime or ceftazidime 2 g IV q8h, Levofloxacin 750 mg IV daily, Ciprofloxacin 400 mg IV q8h, Imipenem 500 mg IV q6h, Meropenem 1 g IV q8h, or Aminoglycoside (amikacin, gentamicin, or tobramycin) 1, 2, 3, 4
• For patients with community-acquired pneumonia requiring ICU admission, the European Respiratory Society recommends using a non-antipseudomonal 3rd generation cephalosporin plus macrolide or moxifloxacin/levofloxacin ± cephalosporin for those without P. aeruginosa risk, and an antipseudomonal cephalosporin or acylureidopenicillin/β-lactamase inhibitor or carbapenem PLUS ciprofloxacin or macrolide + aminoglycoside for those with P. aeruginosa risk 5, 6
• The Infectious Diseases Society of America recommends the following antibiotics for specific pathogens: Penicillin G, ceftriaxone, or high-dose amoxicillin for S. pneumoniae, Oxacillin, cefazolin, or flucloxacillin for MSSA, and Vancomycin, teicoplanin, or linezolid for MRSA 4, 7

Urinary Tract Infection Treatment

• No relevant guidelines were found for urinary tract infection treatment that met the inclusion criteria.

Important Clinical Considerations

• The Infectious Diseases Society of America recommends considering MRSA coverage for patients with prior IV antibiotics within 90 days, hospitalization in a unit with high MRSA prevalence, unknown MRSA prevalence, or high mortality risk 1, 2, 3
• The European Respiratory Society recommends switching from IV to oral therapy when patients are clinically stable, as defined by temperature ≤37.8°C, heart rate ≤100/min, respiratory rate ≤24/min, SBP ≥90 mmHg, O2 saturation ≥90%, and normal mental status 5, 6, 7, 8
• The Infectious Diseases Society of America recommends avoiding common pitfalls such as overuse of broad-spectrum antibiotics, inadequate MRSA coverage, prolonged IV therapy, inadequate dosing, and monotherapy for P. aeruginosa 1, 3, 4, 5, 6
• The European Respiratory Society recommends considering local antibiogram when selecting empiric therapy and adjusting dosing in renal impairment according to creatinine clearance 1, 4, 5