Pending culture results
and susceptibility testing:
Reasonable
first-choice: cefotaxime or
ceftriaxone
Cefotaxime
(Claforan), ceftriaxone
(Rocephin), high-doses of
penicillin (IV) effective
in treating pneumococcal
pneumonia (intermediate
resistance)
Vancomycin (Vancocin):
high resistance
Vancomycin (Vancocin)
and cephalosporin: severe
illness-- not responding to a beta-lactam.
A macrolide (erythromycin,
azithromycin (Zythromax), or
clarithromycin (Biaxin)) added to
a fluoroquinone (good activity
against S. pneumoniae -- levofloxacin (Levaquin),
grepafloxacin and trovafloxacin)
can be used to cover Legionella, Mycoplasma,
chlamydia.
If
aspiration pneumonia is a
concern: clindamycin
(Cleocin) or
metronidazole (Flagyl)
may be added.