Respiratory tract infections

Respiratory tract infections
Clinical condition Common pathogens Empirical antimicrobial agents Alternative antimicrobial agents Comments
Pneumonia     S. pneumoniae, H. influenzae, Legionella spp, K. pneumoniae, P. aeruginosa, Acinetobacter spp Piperacillin-tazobactam
plus
azithromycin or
doxycycline Duration 5-7 days
Imipenem-cilastatin If MRSA is a concern, add linezolid. Avoid fluoroquinolones unless TB excluded.
Consider TB, influenza, Nocardia, fungi.
Pneumocystis jirovecii Co-trimoxazole Clindamycin
plus
primaquine (if sulpha allergy)
 
Lung abscess, empyema S. pneumoniae, viridans streptococci,
K. pneumoniae, P. aeruginosa, S. aureus
Piperacillin-tazobactam Cefoperazone-sulbactam + clindamycin Drainage of pleural space essential for empyema.
Duration: 3-4 weeks
Acute bacterial pharyngitis Streptococcus pyogenes Benzathine penicillin or amoxycillin   Most cases viral. Confirm bacterial etiology before antibiotic Rx
Head & neck space infections Polymicrobial, S. pyogenes,
S. aureus, viridans streptococci, oral anaerobes
Clindamycin or amoxy-clav Piperacillin-tazobactam  
Acute sinusitis Viral,
S. pneumoniae, H. influenzae, M. catarrhalis
Amoxy-clav Piperacillin-tazobactam Exclude fungal etiology
Acute bronchitis Mostly viral     Antibiotics not needed