What are the recommended medications for common diseases like pneumonia, influenza, hypertension, and diabetes?

Medications for Common Diseases

Pneumonia

For community-acquired pneumonia, treatment depends on severity and location of care, with combination therapy (beta-lactam plus macrolide or respiratory fluoroquinolone alone) recommended for hospitalized patients. 1

Outpatient Treatment (Non-hospitalized)

• Previously healthy patients without risk factors for drug-resistant S. pneumoniae: Use a macrolide (azithromycin, clarithromycin, or erythromycin) as first-line therapy 1

• Alternative for previously healthy patients: Doxycycline can be used 1

• Patients with comorbidities (chronic heart/lung/liver/renal disease, diabetes, alcoholism, malignancies, immunosuppression, or recent antibiotic use within 3 months):

  • Respiratory fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin 750 mg) 1
  • OR beta-lactam plus macrolide: high-dose amoxicillin (1 g three times daily) or amoxicillin-clavulanate (2 g twice daily) plus a macrolide 1
  • Alternative beta-lactams include ceftriaxone, cefpodoxime, or cefuroxime (500 mg twice daily) 1

Inpatient Treatment (Non-ICU)

• Preferred regimen: Respiratory fluoroquinolone (levofloxacin or moxifloxacin) 1
• Alternative combination therapy: Beta-lactam (cefotaxime, ceftriaxone, or ampicillin) plus macrolide 1
• Ertapenem is acceptable for selected patients with risk factors for gram-negative pathogens (excluding Pseudomonas) 1
• Doxycycline can substitute for the macrolide 1

Severe Pneumonia (ICU)

• Mandatory combination therapy: Beta-lactam (co-amoxiclav, cefuroxime, or cefotaxime) plus macrolide (clarithromycin or erythromycin) 1
• Alternative: Respiratory fluoroquinolone (levofloxacin 500 mg twice daily) plus either macrolide or beta-lactam 1
• Antibiotics must be administered within 4 hours of admission 2

Duration of Therapy

• Non-severe, uncomplicated pneumonia: 7 days 2, 3
• Severe, microbiologically undefined pneumonia: 10 days 2, 3
• Confirmed/suspected S. aureus or gram-negative pneumonia: 14-21 days 2, 3

---

Influenza

Oseltamivir should be initiated within 48 hours of symptom onset for patients with influenza-like illness and fever >38°C. 2

Antiviral Treatment

• Oseltamivir (neuraminidase inhibitor): Start within 48 hours of symptom onset for maximum benefit 1, 2
• Hospitalized/severely ill patients: Benefit from oseltamivir even when started >48 hours after symptom onset, particularly if immunocompromised 2
• Zanamivir (inhaled): Alternative for patients unable to take oseltamivir 2
• For influenza A: Amantadine or rimantadine are effective 1
• For influenza B: Oseltamivir or zanamivir are effective 1

Antibiotic Use in Influenza

Previously healthy adults with acute bronchitis complicating influenza (without pneumonia) do not routinely require antibiotics. 1, 2, 3

• Consider antibiotics if: Worsening symptoms develop (recrudescent fever, increasing dyspnea), high-risk patients with lower respiratory tract features, or confirmed/suspected bacterial pneumonia 2, 3

Influenza with Non-Severe Pneumonia

• First-line oral therapy: Co-amoxiclav OR doxycycline 1, 2, 3
• Alternatives (penicillin intolerance): Macrolide (clarithromycin or erythromycin) OR respiratory fluoroquinolone (levofloxacin or moxifloxacin) 1, 3
• Parenteral options: IV co-amoxiclav, cefuroxime, or cefotaxime 1, 3

Influenza with Severe Pneumonia

• Immediate parenteral combination therapy: IV co-amoxiclav (or cefuroxime or cefotaxime) PLUS IV macrolide (clarithromycin or erythromycin) 1, 2, 3
• Alternative: Levofloxacin PLUS beta-lactam OR macrolide 1, 3

Supportive Care

• Antipyretics for fever control 2
• Adequate hydration 2
• Avoid aspirin in children (risk of Reye's syndrome) 2

---

Hypertension

Note: The provided evidence does not contain specific hypertension treatment guidelines. Based on general medical knowledge, first-line agents typically include ACE inhibitors, ARBs, calcium channel blockers, and thiazide diuretics, with selection based on patient comorbidities and contraindications.

---

Diabetes

Annual influenza vaccination and at least one lifetime pneumococcal vaccination are recommended for all diabetic patients. 1

Immunizations for Diabetic Patients

• Influenza vaccine: Annually for all diabetic patients ≥6 months of age 1

• Influenza vaccine reduces diabetes-related hospital admissions by up to 79% during flu epidemics 1

• Pneumococcal vaccine: At least one lifetime dose for all adults with diabetes 1

• One-time revaccination indicated for: Patients >64 years previously immunized when <65 years if vaccine given >5 years ago, or patients with nephrotic syndrome, chronic renal disease, or immunocompromised states 1

Preconception Planning

• Target A1C: Normal or <1% above upper limits of normal before conception 1
• Medication adjustments: Statins are pregnancy category X and must be discontinued before conception 1
• ACE inhibitors and ARBs are category D in later pregnancy and should generally be discontinued before pregnancy 1
• Metformin and acarbose are category B; all other oral antidiabetic agents are category C and should generally be discontinued in pregnancy 1

Common Pitfall

Diabetic patients with pneumonia may have higher rates of Staphylococcus aureus in community-acquired pneumonia compared to non-diabetics, though overall mortality is similar 4. This reinforces the importance of empiric coverage that includes anti-staphylococcal activity when treating diabetic patients with pneumonia.