Antibiotic Treatment for 72-Year-Old Female with Pneumonia
For a 72-year-old female with community-acquired pneumonia requiring hospitalization, prescribe combination therapy with amoxicillin plus a macrolide (erythromycin or clarithromycin) orally, or alternatively, levofloxacin 750 mg once daily as monotherapy. 1, 2
Treatment Algorithm Based on Severity and Setting
Non-Severe Community-Acquired Pneumonia (Hospitalized)
Most patients can be adequately treated with oral antibiotics. 1
First-line combination therapy: 1
- Amoxicillin PLUS a macrolide (erythromycin or clarithromycin) is the preferred regimen for patients requiring hospital admission for clinical reasons
- This combination provides coverage for both typical bacteria (including Streptococcus pneumoniae) and atypical pathogens
Alternative monotherapy options: 1, 2
- Levofloxacin 750 mg orally once daily is an appropriate alternative, particularly for patients intolerant of penicillins or macrolides 1
- Moxifloxacin is another respiratory fluoroquinolone option 2
When to use oral monotherapy with amoxicillin alone: 1
- Patients previously untreated in the community
- Patients admitted for non-clinical reasons (e.g., elderly or socially isolated) who would otherwise be treated in the community
Severe Community-Acquired Pneumonia
If the patient has severe pneumonia (requiring ventilatory support or presenting with septic shock), immediate parenteral antibiotics are mandatory: 1
Preferred regimen: 1
- Intravenous co-amoxiclav OR second-generation cephalosporin (cefuroxime) OR third-generation cephalosporin (cefotaxime or ceftriaxone) PLUS intravenous macrolide (clarithromycin or erythromycin)
Treatment duration: 1
- 10 days for microbiologically undefined severe pneumonia
- Extended to 14-21 days if Legionella, Staphylococcus aureus, or Gram-negative enteric bacilli are suspected or confirmed
Route of Administration
Oral route is recommended for non-severe pneumonia unless contraindications exist. 1
Switching from IV to oral: 1
- Transfer to oral regimen once clinical improvement occurs
- Temperature has been normal for 24 hours
- No contraindication to oral route exists
Important Clinical Considerations
Age-related factors for this 72-year-old patient: 1
- Elderly patients may be admitted for social reasons even with non-severe pneumonia
- Consider comorbidities that may influence antibiotic choice and severity assessment
- No dosage adjustment needed for levofloxacin based on age alone 3
Common pitfall to avoid: 1
- Do not use fluoroquinolones as first-line agents in community settings
- Reserve fluoroquinolones for hospitalized patients or specific circumstances (penicillin/macrolide intolerance, concerns about C. difficile)
When to reassess treatment: 1
- Review antibiotic choice on the "post-take" round within first 24 hours
- If patient fails to improve, conduct careful clinical review and consider adding or substituting a macrolide 1
Hospital-Acquired Pneumonia Considerations
If this is hospital-acquired pneumonia (onset ≥48 hours after admission), the approach differs entirely: 1
For low-risk HAP without MRSA risk factors: 1
- Piperacillin-tazobactam 4.5 g IV q6h, OR
- Cefepime 2 g IV q8h, OR
- Levofloxacin 750 mg IV daily
MRSA coverage required if: 1
- Prior IV antibiotic use within 90 days
- Unit MRSA prevalence >20% or unknown
- High mortality risk (ventilatory support needed, septic shock)
- Add vancomycin 15 mg/kg IV q8-12h (target trough 15-20 mg/mL) OR linezolid 600 mg IV q12h 1