Factores Modificadores

Penicillin-resistant and drug-resistant pneumococci

Age > 65 yr
β-Lactam therapy within the past 3 mo
Alcoholism
Immune-suppressive illness (including therapy with corticosteroids)
Multiple medical comorbidities
Enteric gram-negatives
Residence in a nursing home
Underlying cardiopulmonary disease
Multiple medical comorbidities
Recent antibiotic therapy
Pseudomonas aeruginosa
Structural lung disease (bronchiectasis)
Corticosteroid therapy (> 10 mg of prednisone per day)
Broad-spectrum antibiotic therapy for >7 d in the past month
Malnutrition
 USANDO ESTOS FACTORES LOS
PACIENTES FUERON AGRUPADOS
 I - AMBULATORIO SIN HISTORIA DE ENFERMEDAD
CARDIOVASCULAR, AND NO FACTORES MODIFICADORES

ORGANISMS
 TRATAMIENTO
Streptococcus pneumoniae
Mycoplasma pneumoniae
Chlamydia pneumoniae (alone or
as mixed infection)
Hemophilus influenzae
Respiratory viruses
Miscellaneous
Legionella spp.
Mycobacterium tuberculosis
Endemic fungi
AMBULATORIO (PSI ó
Fine I-II / CURB65 0-1)
vía oral 5-7 días.
 Amoxicilina
 Amoxicilina-clavulánico
 Azitromicina
 Claritromicina
 Levofloxacino
 Moxifloxacino
II- AMBULATORIO CON HISTORIA DE ENFERMEDAD
CARDIOVASCULAR, Y FACTORES MODIFICADORES

ORGANISMS THERAPY

Streptococcus pneumoniae β-Lactam

Mycoplasma pneumoniae (oral cefalosporina,cefuroxime ,
Alta dosis de amoxicillina,
Chlamydia pneumoniae
amoxicillina/clavulanate;
Mixed infection o parenteral ceftriaxone
(bacteria plus atypical pathogen or virus) seguido de oral cefalosporina)
Hemophilus influenzae mas
Enteric gram-negatives Macrolide:
Clarithromycina
Respiratory viruses
Azitromicina.
Miscellaneous fluoroquinolone
Moraxella catarrhalis, Legionella spp.,
aspiration (anaerobes), Mycobacterium
tuberculosis, endemic fungi
 III. HOSPITALIZACIÓN – NO UCI - CON:
a. HISTORIA DE ENFERMEDAD CARDIOVASCULAR, Y FACTORES
MODIFICADORES (including being from a nursing home)

ORGANISMS THERAPY

I.V β -lactam (cefalosporina de

Streptococcus pneumoniae (Including DRSP) 3era),
Hemophilus influenzae ampicillin/sulbactam, altas dosis
Mycoplasma pneumoniae ampicillin)
Chlamdia pneumoniae Mas
Mixed infection I.V u oral macrolido
(bacteria plus atypical pathogen) o
Enteric gram-negatives I.V antipneumococcica
Aspiration (anaerobes) fluoroquinolone
Viruses
Legionella spp.
Miscellaneous
M. tuberculosis, endemic fungi,
P. carinii
b. NO HISTORIA DE ENFERMEDAD CARDIOVASCULAR, Y FACTORES
MODIFICADORES

ORGANISMS THERAPY

S. pneumoniae
I.V. clarithromycin alone
H. influenzae
M. pneumoniae If macrolide allergic or intolerant
C. pneumoniae Doxycycline
Mixed infection (bacteria and a β-lactam
plus atypical pathogen) or
Viruses
An antipneumococcal
Legionella spp.
Miscellaneous Fluoroquinolone alone
M. tuberculosis,
endemic fungi, P. carinii
 IV. UCI CON:
a. SIN FACTORES DE RIESGO PARA: PSEUDOMONAS AERUGINOSA

ORGANISMS THERAPY

Streptococcus pneumoniae (including DRSP) I.V β-lactam ( cefalosporina de 3era

generación.
Legionella spp.
mas
Hemophilus influenzae
I.V macrolide
Enteric gram-negative bacilli
Staphylococcus aureus
Mycoplasma pneumoniae
Respiratory viruses
Miscellaneous
Chlamydia pneumoniae,
M tuberculosis, endemic fungi
 b. CON FACTORES DE RIESGO PARA: PSEUDOMONAS
AERUGINOSA

ORGANISMS THERAPY
Selected I.V antipseudomonal β-lactam
(cefepime, imipenem, meropenem,
piperacillin/
tazobactam)
MÁS
P. aeruginosa(22%)
I.V antipseudomonal quinolone
(ciprofloxacin)
O
Selected IV antipseudomonal β -lactam
(cefepime, imipenem, meropenem,
piperacillin/ tazobactam)
MAS
I.V aminoglycoside
plus either
IV macrolide (KLACID)
or I.V nonpseudomonal fluoroquinolone
14-d mortality
Combination therapy: 23.4%
p = 0.0015
Monotherapy: 55.3%