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Inpatient Management: Uncomplicated

A focal consolidation on chest x-ray without pleural effusion


Medications: Bacterial pneumonia

  • A focal consolidation on chest x-ray without an effusion

  • Treatment with ampicillin 75 mg/kg/dose IV q6h (max 2 g/dose) is recommended when pneumonia is suspected and hospitalization is required (Bradley, Byington et al. 2011)

  • A 3rd generation cephalosporin (ceftriaxone 100mg/kg/day or cefotaxime 200 mg/kg/day) IV may be considered as alternative treatment (Kaplan, Mason et al. 2001).

  • If intravenous calcium or calcium containing fluids (i.e. Ringer's lactate) is or will be prescribed cefotaxime is the recommended 3rd generation cephalosporin due to concerns of calcium deposition with the use of ceftriaxone and calcium products (FDA, 2007).

Penicillin allergic patients

  • A third generation cephalosporin (ceftriaxone/cefotaxime) is the preferred alternative in patients who have not had an anaphylactic reaction to penicillin (Kabra, Lodha et al. 2006).

  • If intravenous calcium or calcium containing fluids (i.e. Ringer's lactate) is or will be prescribed cefotaxime is the recommended 3rd generation cephalosporin due to concerns of calcium deposition with the use of ceftriaxone and calcium products (FDA, 2007).

  • Clindamycin (40 mg/kg/day) is recommended for patients with a history of anaphylaxis to penicillin and/or cephalosporin allergy (Kabra, Lodha et al. 2006).At CMH, 15% of non-invasive Streptococcus pneumoniae (pneumococcus) isolates were resistant to clindamycin in 2006.

Antibiotics for Inpatient Treatment of Uncomplicated CAP

Antibiotic

Dose, Frequency, Max Daily Dose/day

Comments

First Line Therapy

Ampicillin

75 mg/kg/dose IV, q 6h (max 2 gm/dose)

High dose ampicillin overcomes the resistance of S. pneumoniae.

Alternative Therapy

Ceftriaxone

100mg/kg/day, IV
(Max: 2 gm/dose; 4 gm/day divided q12h)

Do not prescribe ceftriaxone in patients receiving intravenous calcium or calcium containing fluids (FDA, 2007).

Cefotaxime

200mg/kg/day, IV, q8h
(Max: 12 gm)

 

Penicillin Allergic 

Ceftriaxone

100mg/kg/day, IV
(Max: 2 gm/dose; 4 gm/day divided q12h)

Do not prescribe ceftriaxone in patients receiving intravenous calcium or calcium containing fluids (FDA, 2007).

Cefotaxime

200mg/kg/day, IV, q8h
(Max: 12 gm)

 

Clindamycin

40mg/kg/day IV, q6h
(Max: IV 4.8 gm, PO 1.8 gm)

At CMH, 15% of non-invasive Streptococcus pneumoniae(pneumococcus) isolates were resistant to clindamycin in 2006

*Cost is represented per day as the length of therapy may vary.


Supportive care

  • Intravenous fluids and oxygen are provided, when indicated. Fever and pain are managed.

  • Transition to Oral Antibiotic

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.