Empiric antibiotic choices by infection site, spectrum of coverage, de-escalation, duration of therapy, resistant organisms such as MRSA and ESBL, and stewardship principles.
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- First-line empiric antibiotic for outpatient CAP in a healthy adult with no comorbidities?
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Amoxicillin (or doxycycline/macrolide if local pneumococcal macrolide resistance is low).- Empiric regimen for outpatient CAP in a patient with comorbidities (COPD, diabetes, etc.)?
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Amoxicillin-clavulanate or a cephalosporin plus a macrolide, or a respiratory fluoroquinolone alone.- Empiric regimen for CAP requiring non-ICU hospitalization?
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A beta-lactam (such as ceftriaxone) plus a macrolide, or a respiratory fluoroquinolone.- What should be added to standard severe CAP (ICU) empiric therapy if the patient has MRSA or Pseudomonas risk factors?
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MRSA coverage (vancomycin or linezolid) and/or antipseudomonal coverage.- Two organisms that empiric HAP/VAP therapy must cover?
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MRSA and Pseudomonas aeruginosa.- Why use two antipseudomonal agents from different classes empirically in suspected pseudomonal pneumonia?
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To increase the odds at least one agent is active while cultures are pending, since untreated pseudomonal pneumonia has high mortality.- Name three antipseudomonal beta-lactams.
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Cefepime, piperacillin-tazobactam, and meropenem.- First-line agents for uncomplicated cystitis?
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Nitrofurantoin, TMP-SMX, or fosfomycin.- Why are fluoroquinolones avoided as first-line therapy for uncomplicated cystitis?
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To preserve them for more serious infections and limit resistance and toxicity, per stewardship principles.- Outpatient empiric options for acute pyelonephritis?
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A fluoroquinolone (if local resistance is under 10 percent) or an initial dose of ceftriaxone followed by oral step-down.- Should asymptomatic bacteriuria be treated with antibiotics?
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No, except in pregnancy or before an invasive urologic procedure.- What must empiric therapy for community-acquired intra-abdominal infection cover?
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Enteric gram-negative rods and anaerobes, for example ceftriaxone plus metronidazole, or piperacillin-tazobactam alone.- Empiric antibiotic for spontaneous bacterial peritonitis?
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A third-generation cephalosporin such as cefotaxime.- What organism does empiric therapy for non-purulent cellulitis mainly target?
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Beta-hemolytic streptococci (treated with cephalexin, not MRSA coverage).- What organism must empiric therapy for purulent skin and soft tissue infection cover?
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MRSA, using agents like TMP-SMX, doxycycline, or clindamycin.
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