Acute, Failure of first line agents
- clinical deterioration after 72 h of antibiotic therapy
- no improvement post therapy
- recurrence within 3 months
- Need to consider resistant organisms, especially penicillin-resistant S. pneumoniae, ampicillin-resistant H. influenzae, and M. catarrhalis.
Usual Pathogens
S. pneumoniae
M. catarrhalis
H. influenzae
Occasionally:
S. aureus
Group A Streptococci
Anaerobes
Second line agents
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Amoxicillin-clavulanate | 875mg PO bid | 5-10 days |
| +/- | ||
| Amoxicillin | 1g PO bid | 5-10 days |
ß-lactam allergy
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Levofloxacin | 750mg PO daily | 5-10 days |