(Current Therapy in Community-Acquired Pneumonia)

1-000-SPU-000-0502-01
2
: 2 2548
: 2 2550

.. , ..

1.
2.
3.
4.

Streptococcus pneumoniae, Mycoplasma pneumoniae Chlamydia
pneumoniae
macrolides azithromycin

cephalosporins 3 macrolides fluoroquinolones
ceftriaxone azithromycin moxifloxacin
aminoglycosides
: community-acquired pneumonia, pneumonia, CAP guideline, ,

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(Current Therapy in Community-Acquired Pneumonia)

2-3
(neutropenic patients) (1)

12 1,000 (2) 1
5
20-40%(3)
5-6 1.7 (4)

atypical
pathogens
1 (1,6,7)

Gram-positive cocci
Streptococcus pneumoniae
Staphylococcus aureus
Gram-negative bacilli
Haemophilus influenzae
Atypical pathogens
Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella spp.
Virus
Unknown

(%)

(%) ()
Non-ICU
ICU

5-15
0-1

12-24
-

9-55
1-3.6

12-38
1-18

2-12

4-12

2-13

17-37
5-10
0-3
0-19
41-55

6-13
17-32
6-10
20-34

1-32
6-43
1-6
0-16
-

1-7
3-30
1-14
-

1
() S.pneumoniae
(pneumococcus), M.pneumoniae C.pneumoniae
S.pneumoniae
2

Thai Journal of Pharmacy (on-line version)

Vol. 1 No.2 February 2005

2 Pneumocystic carinii(1)

melioidosis Burkholderia pseudomallei
(1,2,8)

-
-

65
(heart failure)

(1,8)

60-70%
(6,8)
3
1.
2.
3. (ICU)
1.
24
2 60
60 (2)
2.
65
40 35
90/60 24 30
/
- 400 30,000

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-

(Arterial Partial Pressure of Oxygen; PaO2) < 60

- (arterial pH) < 7.35

(Blood Urea Nitrogen; BUN) > 20
(Serum Creatinine; SCr) > 1.2
(multilobar pneumonia)
(pleural effusion) (lung abscess)

(1,2,6-8)
3. (Intensive Care Unit; ICU)
50%
30
/ 90/60
(1,2,6)

(1,7)

65 (bacteremia)
(leukopenia)
(empyema)

1.: (pleuritic chest pain)
2 (4,6,7)


(4,6,8)
2.: (rale)
(consolidation)
3. (Chest X-ray):

Thai Journal of Pharmacy (on-line version)

Vol. 1 No.2 February 2005

3 (1,7)
1.

2. (Complete Blood Count;

CBC), ( )

3.

urinary antigen Legionella spp. S.pneumoniae
direct stain acid-fast Mycobacterium

(empiric antibiotics regimen)

(4)



(6,8)
2 CAP Year 2003
ASCAP (Antibiotic selection for Community-Acquired Pneumonia Guidelines for CAP)
(1,4)

60

60

azithromycin PO 500 mg qd
2-5 250 mg qd

moxifloxacin PO 400 mg qd 7-14 ,

levofloxacin PO 500 mg qd 7-14 ,
gatifloxacin PO 400 mg qd 7-14 ,
clarithromycin PO 1,000 mg qd 10
nd
rd
levofloxacin PO 500 mg qd 7-14 ,
2 or 3 cephalosporins
-lactam/-lactamase inhibitor gatifloxacin PO 400 mg qd 7-14 ,
clarithromycin PO 1,000 mg qd 10
new macrolides
newfluoroquinolones
( azithromycin, moxifloxacin)

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ceftriaxone IV 1g 24
azithromycin IV 500 mg qd 2-5

azithromycin PO 500 mg qd
7-10
ceftriaxone IV 1g 24
moxifloxacin 400 mg qd 7-14

cefepime IV 1-2 g 12 . 5-10

levofloxacin IV 500 mg qd
bronchiectasis 7-14 aminoglycosides
ciprofloxacin IV
400 mg 8-12 .
7-14 aminoglycoside IV
azithromycin IV
ceftriaxone IV 1g 24
(suspected aspiration)
azithromycin IV
clindamycin IV 1.2-1.8 g
2-4
4.8 g

moxifloxacin IV 400 mg qd 7-14 ,

levofloxacin IV 500 mg qd 7-14 ,
gatifloxacin IV 400 mg qd 7-14

vancomycin IV 2 g
6-12 . azithromycin IV
500 mg qd 2-5
azithromycin PO 500 mg
qd 7-10
ceftriaxone IV 1g 24
levofloxacin IV 500 mg qd 7-14
ciprofloxacin IV 400 mg 8-12 .
7-14 cefepime IV 1-2 g
12 . 5-10
azithromycin IV carbapenem
IV azithromycin
IV aminoglycosides

levofloxacin IV 500 mg qd 7-14

clindamycin IV 1.2-1.8 g
2-4
4.8g
levofloxacin IV 500 mg qd 7-14
metronidazole IV 500 mg
6-8 . 4 g
gatifloxacin IV 400 mg qd 7-14
clindamycin IV 1.2-1.8 g
2-4
4.8g
CAP
moxifloxacin IV 400 mg qd 7-14
levofloxacin IV 500 mg qd 7-14
vancomycin IV 2g
vancomycin IV 2g
6-12 .
6-12 .
ceftriaxone IV 1g 24 ceftriaxone IV 1g 24
(ICU)
levofloxacin IV 500 mg qd 7-14 azithromycin
anti-pseudomonal agents
aminoglycosides
( P.aeruginosa) cefepime IV 1-2 g 12 .
ceftriaxone IV 1g 24 5-10 aminoglycosides IV
moxifloxacin IV 400 mg qd 7-14
moxifloxacin IV 400 mg qd

Thai Journal of Pharmacy (on-line version)

Vol. 1 No.2 February 2005

anti-pseudomonal agents

7-14 carbapenem IV
aminoglycosides IV
azithromycin IV

* : levofloxacin

4-8
8
(4,6)
Klebsiella pneumoniae, Escherichia
coli Pseudomonas aeruginosa (2,4,8)

S.pneumoniae (Drug resistant S.pneumoniae; DRSP)

(2,4,8)

1. 60
atypical pneumonia DRSP
macrolides azithromycin
clarithromycin fluoroquinolones levofloxacin, gatifloxacin moxifloxacin
macrolides atypical
pathogens azithromycin clarithromycin H.influenzae macrolide-resistant
S.pneumoniae erythromycin(2,3,4,7) azithromycin

clarithromycin(2,4,7) fluoroquinolones S.pneumoniae, H.influenzae,
M.catarrhalis, M.pneumoniae L.pneumophila

fluoroquinolones moxifloxacin S.pneumoniae
levofloxacin gatifloxacin
lung fluid levofloxacin
fluoroquinolones concentration-dependent(11,12)
7

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fluoroquinolones
fluoroquinolones ciprofloxacin
S.pneumoniae atypical pathogens (4)
2. 60 /
DRSP moxifloxacin
DRSP macrolides DRSP

3.
cephalosporins 3
macrolides ()
cephalosporins 3 DRSP macrolides
atypical pathogens(1,4,7) ceftriaxone azithromycin
cephalosporins 3 cefotaxime ceftriaxone pneumococci
ceftrixone cephalosporin of choice(4,7) S.pneumoniae
cefotaxime(4) 1 (2,4)
4.
ceftriaxone moxifloxacin S. pneumoniae macrolides /
penicillins fluoroquinolones cephalosporins
S.pneumoniae fluoroquinolones, cephalosporins 3 macrolides
vancomycin (4)
5. bronchiectasis
P.aeruginosa polymicrobial cefepime
levofloxacin aminoglycosides(1,4)
6. (suspected aspiration)
ceftriaxone
azithromycin clindamycin clindamycin
(4)

Thai Journal of Pharmacy (on-line version)

Vol. 1 No.2 February 2005

7.
methicillin-resistant S.aureus (MRSA) MRSA
moxifloxacin vancomycin
8.
K.pneumoniae, E.coli P.aeruginosa
ceftriaxone fluoroquinolones moxifloxacin ceftriaxone
macrolides azithromycin atypical pathogens

aminoglycosides gentamicin
fluoroquinolones
fluoroquinolones (1,4)

7-14

(switch therapy)

24
(1,2,6)
(2,6)


(1,6)
(1,6)
24-48
72

72 2448

72 24-48

24-48
9

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1-3

macrolides, fluoroquinolones cephalosporins 3,4

1.
,
, , Current Practice in Common Infectious Diseases
2545: 197-218
2.
, 4
4 2545: 271-4
3.
American Thoracic Society. Guideline for the management of adults with community-acquired
pneumonia. Am J Respir Crit Care Med 2001; 163: 1735-52.
4.
Antibiotic Selection for Community-Acquired Pneumonia (ASCAP) Panel. CommunityAcquired Pneumonia (CAP): Evidence-based Antibiotic Selection and Outcome-Effective
Patient Management-Year 2003 Update. Hospital Medicine Consensus Reports: 1-33.
5.
Underwood JE. Lower Respiratory Tract Infectious, In: Herfindal ET, Gourley DR Textbook of
Therapeutics: Drug & Disease Management. 6th ed. Maryland:
Williams & Wilkins, 1996: 1269-81.
6.
4 2
2546: 271-5
7.
Thomas MFJ. Community-acquired pneumonia. Lancet 2003; 362: 1991-2001.
8.
, , ,
Clinical Practice Guideline 3
2544: 271-6
9.
Fine MJ, Auble TE, Yearly DM, et al. A prediction rule to identify low-risk patients with
community-acquired pneumonia. New Eng J Med 1997; 336: 243-50.
10

Thai Journal of Pharmacy (on-line version)

Vol. 1 No.2 February 2005

10.
11.

12.

British Thoracic Society. Guidelines for the management of community-acquired pneumonia in

adults. Thorax 2001, 56: iv 1-64.

2 (1996) 2542:
58-60
Application of Pharmacokinetics and Pharmacodynamic Principles in
Rational Antimicrobial Use , Advances in
Pharmaceutical Care and Pharmacotherapeutics 2546: 80-8

11