A 65 year old man has been admitted to your Intensive Care Unit with a presumptive diagnosis of community acquired pneumonia. He is sedated, intubated and ventilated, and is haemodynamically stable.
(c) What empiric therapy would you commence (drugs, dosage, route and duration)? Discuss why.
One example would be: Erythromycin 1 g IV 6 hrly plus ceftriaxone 1 g IV daily. Covers common pathogens including atypicals and Haemophilus (but not pseudomonas, Pneumocystis, Burkholderia), well tolerated, reasonably cheap.
Current guidelines recommend a broad-spectrum third generation cephalosprin (eg. ceftriaxone 1g bd) and a macrolide (eg. azithromycin 500mg daily). These should be given IV, for a minimum of 5 days (but more likely for 7)
The most recent NICE guidelines make the following recommendations for the British pneumonia patient with moderate or severe disease:
- 7-10 days of antibiotics
- Dual therapy (a β lactam and a macrolide) for severe pneumonia.
Mandell, Lionel A., et al. "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults." Clinical infectious diseases 44.Supplement 2 (2007): S27-S72.