Bacterium

Streptococcus pneumoniae
Penicillin MIC <2 g/mL
Penicillin MIC 2 g/mL

Preferred Therapies
Penicillin G, amoxicillin
Agents chosen based on in vitro
susceptibility, including cefotaxime,
ceftriaxone, respiratory fluoroquinoloned

Haemophilus influenzae
Non-lactamase producing Amoxicillin
-Lactamase producing

Second- or third-generation cephalosporin,

amoxicillin-clavulanate
Mycoplasma pneumoniae or Macrolidea, a tetracycline
Chlamydophila pneumoniae
Legionella species
Fluoroquinoloned,e, azithromycin
Enterobacteriaceae
Third-generation cephalosporin,
carbapenemg,h
Pseudomonas aeruginosa
Antipseudomonal -lactamj plus
ciprofloxacin or levofloxacin or an
aminoglycoside
Acinetobacter species
Carbapenemg
Staphylococcus aureus
Methicillin-susceptible
Methicillin-resistant
Anaerobes (aspiration)
Chlamydophila psittaci
Coxiella burnetii
Bacillus anthracis
Yersinia pestis
Francisella tularensis
Bordetella pertussis

Antistaphylococcal penicillink
Vancomycin, linezolid
-Lactam/-lactamase inhibitori,
clindamycin
A tetracycyline
A tetracycline
Ciprofloxacin, levofloxacin, doxycycline
(usually with a second agent)
Streptomycin, gentamicin
Doxycycline
Macrolidea

Alternative Therapies
Macrolidea, oral cephalosporinb, parenteral
cephalosporinc, clindamycin, doxycycline,
respiratory fluoroquinoloned
Vancomycin, linezolid, high-dose amoxicillin
(3 g/d)

Fluoroquinoloned,e, doxycycline,
azithromycin, clarithromycinf
Fluoroquinoloned,e, doxycycline,
azithromycin, clarithromycinf
Fluoroquinoloned
Doxycycline
-Lactam/-lactamase inhibitor combinationi
Aminoglycoside plus ciprofloxacin or
levofloxacin
Cephalosporin plus an aminoglycoside,
ampicillin-sulbactam, colistin
Cefazolin, clindamycin
Trimethoprim-sulfamethoxazole
Carbapenemg
Macrolidea
Macrolidea
Other fluoroquinolone, -lactam (if
susceptible), rifampin, clindamycin,
chloramphenicol
Doxycycline, fluoroquinolone
Gentamicin, streptomycin
Trimethoprim-sulfamethoxazole

CAP = community-acquired pneumonia; MIC = minimal inhibitory concentration.

a
Azithromycin, clarithromycin, or erythromycin.
b
Cefpodoxime, cefprozil, cefuroxime axetil, cefdinir, cefditoren.
c
Cefuroxime, ceftriaxone, cefotaxime.
d
Levofloxacin, moxifloxacin, or gemifloxacin.
e
Ciprofloxacin is appropriate for Legionella species and most gram-negative bacilli.
f
Azithromycin is more active in vitro than clarithromycin against Haemophilus influenzae.
g
Imipenem-cilastatin, meropenem, or ertapenem.
h
Drug of choice if extended-spectrum lactamase producer.
i
Piperacillin-tazobactam for gram-negative bacilli, ticarcillin-clavulanate, ampicillin-sulbactam, amoxicillinclavulanate.
j
Piperacillin, piperacillin-tazobactam, cefepime, ceftazidime, imipenem, meropenem.
k
Nafcillin, oxacillin.