From the Guidelines
Good antibiotic inpatient utilization requires implementing an effective antimicrobial stewardship program that includes appropriate empiric therapy followed by targeted treatment based on culture results, as recommended by the American Thoracic Society and Infectious Diseases Society of America in their 2019 guideline 1. To achieve this, the initial treatment strategy for inpatients with community-acquired pneumonia should be based on the level of severity and risk for drug resistance.
- For nonsevere inpatients, a standard regimen of a beta-lactam plus a macrolide or respiratory fluoroquinolone is recommended, such as ampicillin-sulbactam 1.5-3 g every 6 hours, cefotaxime 1-2 g every 8 hours, or ceftriaxone 1-2 g daily, combined with azithromycin 500 mg daily or clarithromycin 500 mg twice daily 1.
- For severe inpatients, a beta-lactam plus a macrolide or beta-lactam plus a fluoroquinolone is recommended, with the addition of MRSA coverage and obtaining cultures/nasal PCR to allow de-escalation or confirmation of need for continued therapy 1. It is also crucial to limit vancomycin to suspected MRSA infections with documented high local prevalence or patient risk factors, and to monitor therapeutic drug levels to prevent toxicity while ensuring efficacy 1. Daily antibiotic timeouts should assess continued need, appropriate spectrum, dose adjustments for organ dysfunction, and conversion to oral therapy when patients are clinically improving with good GI function. This approach optimizes patient outcomes while minimizing adverse effects, reducing resistance development, and decreasing healthcare costs associated with unnecessary antibiotic use.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Good Antibiotic Inpatient Utilization
- The use of antibiotics in inpatient settings is crucial for treating various infections, including community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) 2, 3, 4.
- Studies have shown that combination therapy with ceftriaxone and azithromycin is effective in treating CAP, with clinical success rates of 84.3% and 82.7% in the modified intent-to-treat population at the end of therapy (EOT) 2.
- The use of piperacillin/tazobactam has also been shown to be effective in treating early, non-ventilator HAP, with a lower risk of clinical failure compared to ceftriaxone plus clindamycin 4.
- Azithromycin is often prescribed for atypical antimicrobial cover in severe CAP, but its use should be guided by criteria such as the CURB-65 score and electrocardiograms to assess the QTc interval 5.
- Despite the increasing prevalence of macrolide resistance in Streptococcus pneumoniae, azithromycin remains protective in ICU patients with CAP, with a significant reduction in in-hospital mortality 6.
Antibiotic Regimens
- Ceftriaxone plus azithromycin is a recommended regimen for hospitalized patients with CAP without risk factors for resistant bacteria 3.
- Piperacillin/tazobactam is a suitable alternative for early, non-ventilator HAP, with a lower risk of clinical failure compared to ceftriaxone plus clindamycin 4.
- Azithromycin should be used judiciously, with consideration of the CURB-65 score and electrocardiograms to assess the QTc interval 5.
Considerations for Antibiotic Use
- Disease severity and the likelihood of bacterial infection or resistant infection should be considered when selecting empirical antibacterial therapy 3.
- The risk of harm from overuse of antibacterial drugs should also be taken into account 3.
- Regular monitoring of antibiotic resistance patterns and adjustment of treatment regimens accordingly is crucial for effective antibiotic utilization 6.