台灣肺炎治療準則 2000 Taiwan Pneumonia Antimicrobial Treatment Guideline 2000 中華民國感染症醫學會 台灣胸腔及重症加護醫學會

1. 台灣肺炎治療準則2000Taiwan Pneumonia Antimicrobial Treatment Guideline 2000中華民國感染症醫學會台灣胸腔及重症加護醫學會

2. Community -Acquired Pneumonia Age group Primary Alternative <2m Ampicillin+ Aminoglycosides Ampicillin+ cefotaxime (or ceftriaxone) ± Erythromycin 2m-2y Ampicillin/sulbactam Ceftriaxone (or cefotaxime) Amoxicillin/clavulanate Ceftazidime  2º cephalosporins Aminoglycoside 2y-5y Ampicillin/sulbactam Ceftriaxone (or cefotaxime) Amoxicillin/clavulanate 2º cephalosporins ± Erythromycin or new macrolides 5y- 18y Penicillin  Erythromycin Ampicillin/sulbactam or new macrolides Amoxicillin/clavulanate 2º and 3ºcephalosporins

3. Community -Acquired Pneumonia Age group Primary Alternative 19- 60y Penicillin  Erythromycin Ampicillin/sulbactam or new macrolides Amoxicillin/clavulanate 2º cephalosporins Tetracycline Fluoroquinolones >60y Mild-moderate Penicillin or 2º cephalosporins Ampicillin/sulbactam  Erythromycin Tetracycline or new macrolides Amoxicillin/clavulanate Newer fluoroquinolones Severe 3º cephalosporins or Fluoroquinolones or Ureidopenicillins  Ticarcillin/clavulanate or Aminoglycosides  Piperacillin/tazobactam or Erythromycin or 4º cephalosporins  new macrolides Aminoglycosides  Erythromycin or new macrolides

4. Aspiration Pneumonia (Including Lung abscess) Pathogens Primary Alternative Anaerobes Penicillin Penicillin + metronidazole S. pneumoniae Clindamycin 2 Cephalosporins Other Streptococci Ampicillin/sulbactam Enterobacteriaceae Amoxicillin/clavulanate

5. Hospital -Acquired Pneumonia Pathogens Primary Alternative Mild to moderate Ampicillin/sulbactam or Ticarcillin/clavulanate or Amoxicillin/clavulanate or Piperacillin/tazobactam or 2º or 3º cephalosporins or Aztreonam or Ureidopenicillins  Fluoroquinolones  Aminoglycosides Aminoglycosides Severe 3º cephalosporins or Ticarcillin/clavulanate or Ureidopenicillins or Piperacillin/tazobactam or Fluoroquinolones + Aztreonam or Aminoglycosides  Imipenem or meropenem or Erythromycin or 4º cephalosporins + newer macrolides  Aminoglycosides  Vancomycin or teicoplanin Erythromycin or newer macrolides  Vancomycin or teicoplanin

6. Ventilator Associated Pneumonia Pathogens Primary Alternative P. aeruginosa 3º cephalosporins or Ticarcillin/clavulanate or Acinetobacter Ureidopenicillins or Piperacillin/tazobactam or MRSA Fluoroquinolones + Aztreonam or Aminoglycosides  Imipenem or meropenem or Vancomycin or teicoplanin 4º cephalosporins + Aminoglycosides  Vancomycin or teicoplanin

7. Community -Acquired Pneumonia Pathogens Primary Alternative Streptococcus pneumoniae Penicillin MIC  1 g/mL Penicillin 1° Cephalosporins Ampicillin or amoxicillin 2 g/mL Penicillin (12-18MU/d) 3ºor 4° cephalosporins Ampicillin or amoxicillin  4 g/mL 3ºor 4° cephalosporins Vancomycin or teicoplanin Vancomycin or teicoplanin + Rifampicin Newer fluoroquinolone

8. Community -Acquired Pneumonia Pathogens Primary Alternative Haemophilus influenza -lactamase (-) Ampicillin or amoxicillin New macrolides TMP/SMX -lactamase (+) Ampiclllin/sulbactam3ºcephalosporins Amoxicillin/clavulanate New macrolides 2° cephalosporins Fluoroquinolones Moraxella catarrhalisAmpiclllin/sulbactamErythromycin Amoxicillin/clavulanate or new macrolides 2° cephalosporins 3ºcephalosporins FluoroquinoloneS

9. Community -Acquired Pneumonia Pathogens Primary Alternative Legionella speciesErythromycin or Erythromycin or new macrolidesnew macrolides + Rifampicin Tetracycline Fluoroquinolones Mycoplasma pneumoniaErythromycin or Tetracycline new macrolides Fluoroquinolones Chlamydia pneumoniae Tetracycline Fluoroquinolones Erythromycin or new macrolides