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Walk the Even Hospital Database by book and chapter — the raw source passages that ground Ask, DDx, and the rest.
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Low severity (eg, CURB65 = 0-1 or CRB65 score = 0, <3 percent mortality) Home Amoxicillin 500 mg orally three times daily Doxycycline 200 mg loading dose then 100 mg orally once daily or clarithromycin 500 mg orally twice daily
Low severity (eg, CURB65 = 0-1, <3 percent mortality) but admission indicated for reasons other than pneumonia severity (eg, social reasons/unstable comorbid illness) Hospital Amoxicillin 500 mg orally three times daily If oral administration not possible: amoxicillin 500 mg IV three times daily* Doxycycline 200 mg loading dose then 100 mg orally once daily or clarithromycin 500 mg orally twice daily
Moderate severity (eg, CURB65 = 2, 9 percent mortality) Hospital Amoxicillin 500 mg to 1 gram orally three times daily plus clarithromycin 500 mg orally twice daily If oral administration not possible: amoxicillin 500 mg IV three times daily* or benzylpenicillin (penicillin G) 1.2 grams IV four times daily plus clarithromycin 500 mg IV twice daily* Doxycycine 200 mg loading dose then 100 mg orally or levofloxacin 500 mg orally once daily or moxifloxacin 400 mg orally once daily•
Antibiotics given as soon as possible Co-amoxiclav (amoxicillin-clavulanate potassium) 1.2 grams IV three times daily* plus clarithromycin 500 mg IV twice daily* (If Legionella strongly suspected, consider adding levofloxacinΔ) Benzylpenicillin (penicillin G) 1.2 grams IV four times daily plus either levofloxacin 500 mg IV twice daily or ciprofloxacin 400 mg IV twice daily
OR Cefuroxime 1.5 grams IV three times daily or cefotaxime 1 gram IV three times daily or ceftriaxone 2 grams IV once daily, plus clarithromycin 500 mg IV twice daily* (If Legionella strongly suspected, consider adding levofloxacinΔ) This table provides the 2009 guideline recommendations of the British Thoracic Society (BTS) for reference purposes. Please see the UpToDate text for information about choosing between the different guidelines and about the preferred doses and durations of the individual antibiotics. IV: intravenous. * Intravenous preparation not available in the United States. • Following reports of an increased risk of adverse hepatic reactions associated with oral moxifloxacin, in October 2008 the European Medicines Agency (EMEA) recommended that moxifloxacin "should be used only when it is considered inappropriate to use antibacterial agents that are commonly recommended for the initial treatment of this infection". Δ Caution: Risk of QT prolongation with macrolide-quinolone combination. Reproduced with permission from: Lim WS, Baudouin SV, George RC, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 2009; 64 Suppl 3:iii1. Copyright © 2009 BMJ Publishing Group Ltd.