Antibiotics for severe community-onset pneumonia 


Atypical coverage always 


- Usually azithromycin 500 mg daily 


- Doxycycline if animal exposure or 

contraindication to azithromycin 

Beta-lactam backbone 


- Usually ceftriaxone (safe for non•anaphylactic penicillin allergy) 

Consider two grams IV daily esp. in heavier patients. 

- Risk for pseudomonas: cefepime or piperacillin-tazobactam 


Septic Shock


Structural lung disease (severe COPD, bronchiectasis, cystic fibrosis) 


Broad-spectrum antibiotics for >7 days in past month 


Hospitalization for > 1 day in last three months 


Immunocompromise (e.g. chemotherapy, steroid > I Omg/d) 


Nursing home resident with poor functional status 


- History of penicillin anaphylaxis: meropenem 


- Don't use ceftazidime (poor gram-positive coverage) 

MRSA coverage? 


only in selected cases 


- Linezolid 1 st line 600 mg ql 2hr 


- Vancomycin 


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