Antibiotic Treatment CAP

( Empirical antimicrobial therapy ).

Outpatient treatment
A. Macrolide (azithromycin, clarithromycin, or erythromycin)
B. Doxycycline

Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines

Antibiotic Treatment CAP

( Empirical antimicrobial therapy ).

Outpatient treatment

Ada Penyakit Penyerta :

A. Fluoroquinolone (moxifloxacin, gemifloxacin, or

levofloxacin )
B. Beta-lactam plus a macrolide (High-dose amoxicillin
or amoxicillin-clavulanate; alternatives include
ceftriaxone, cefpodoxime, and cefuroxime
doxycycline

Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines

Antibiotic Treatment CAP

( Empirical antimicrobial therapy ).

Inpatient, Non-ICU treatment

Fluoroquinolone
Beta-lactam plus a macrolide (Preferred b-lactam
agents include cefotaxime, ceftriaxone, and
ampicillin; ertapenem for selected patients;
Fluoroquinolone should be used for penicillin-allergic
patients.
Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines

Antibiotic Treatment CAP

( Empirical antimicrobial therapy ).

Inpatient, ICU treatment

b-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) plus either azithromycin or
a fluoroquinolone
(For penicillin-allergic : fluoroquinolone and aztreonam are recommended.)
For Pseudomonas infection, use (piperacillin-tazobactam, cefepime, imipenem, or
meropenem) plus either ciprofloxacin or levofloxacin (750-mg dose)
or
the above b-lactam plus an aminoglycoside and azithromycin
or
the above b-lactam plus an aminoglycoside and an antipneumococcal
fluoroquinolone (for penicillin-allergic , substitute aztreonam for the above b-lactam).
For community-acquired methicillin-resistant Staphylococcus aureus infection, add
vancomycin or linezolid.
Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines

Antibiotic Treatment CAP

( Empirical antimicrobial therapy ).

Inpatient, ICU treatment

b-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam)
plus either azithromycin or a fluoroquinolone
For penicillin-allergic :
( fluoroquinolone and aztreonam are recommended.)

Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines

Antibiotic Treatment CAP

( Empirical antimicrobial therapy ).

Inpatient, ICU treatment

For Pseudomonas infection, use (piperacillin-tazobactam,

cefepime, imipenem, or meropenem) plus either ciprofloxacin or
levofloxacin (750-mg dose)
or
the above b-lactam plus an aminoglycoside and azithromycin
or
the above b-lactam plus an aminoglycoside and an
antipneumococcal
fluoroquinolone (for penicillin-allergic , substitute aztreonam for the
above b-lactam).
.
Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines

Antibiotic Treatment CAP

( Empirical antimicrobial therapy ).

Inpatient, ICU treatment

For community-acquired methicillin-resistant Staphylococcus

aureus infection, add vancomycin or linezolid.

Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines

Terapi Antibiotika Pneumonia

Rawat Inap

Rawat Jalan
Comorbid (-)

- Macrolide

Comorbid (+)

Non ICU

ICU

- Fluoroquinolon
- -lactam + Macrolide
- -lactam + Macrolide/ Fluoroquinolon

Pneumonia Nosokomial
(Hospital Aquired Pneumonia)

Algoritma klasifikasi Pneumonia Nosokomial

Beratnya Penyakit
Ringan - sedang

Berat

Faktor Risiko

Faktor Risiko

Tidak ada

Ada

Tidak ada

Ada

Onset setiap saat

Onset setiap saat

Onset DINI

Onset LAMBAT

Onset setiap waktu

Kelompok I

Kelompok II

Kelompok I

Kelompok III

Kelompok III

Buku Ajar Ilmu Penyakit Paru FK UNAIR RSUD Dr Soetomo 2004

Kelompok I : Pneumonia ringan-sedang, onset setiap saat, faktor risiko

(-) atau pneumonia berat dengan onset dini & faktor risiko (-)

Patogen potensial
Streptococcus pneumoniae
Haemophilus influenza
Metisilin sensitif staphylococus
aureus ( MSSA )
Gram negatif enterik
- E coli
- Klebsiella pneumonia
- Enterobacter sp
- Proteus spp

Antibiotika yg
direkomendasikan
Sefalosporin G 3 nonpseudomonal
( Seftriakson, Sefotaksim )
Atau
Betalaktam + antibetalaktamase
( Amoksisilin klavulanat )
Atau (Jika alergi Penicilin )
Quinolon ( Levofloksasin,
Moksifloksasin, Gatifloksasin )

Pedoman Diagnosis & Penatalaksanaan Pneumonia Nosokomial PDPI 2005

Kelompok II : Pneumonia ringan-sedang, onset setiap saat, faktor risiko (+)

Patogen potensial
Streptococcus pneumoniae

Haemophilus influenza
Metisilin resisten staphylococus
aureus ( MRSA )
Gram negatif enterik
- E coli
- Klebsiella pneumonia
- Enterobacter sp
- Proteus spp

Antibiotika yg direkomendasikan
Sefalosporin G 2/3 nonpseudomonal
( Seftriakson, Sefotaksim )
Atau

Quinolon ( Levofloksasin, Moksifloksasin,

Gatifloksasin )
Atau

Betalaktam + antibetalaktamase
( Amoksisilin klavulanat )

Jika curiga : Anaerob

Klindamisin atau Mertronidazol

Jika curiga : Legionella spp

Makrolid atau Fluorokuinolon

Jika curiga : MRSA

Vankomisin

Jika curiga : Pseudomonas Aeroginosa

Sesuai kelompok II

Kelompok III : Pneumonia berat, onset setiap saat, faktor risiko (+)
spesifik dan atau pneumonia berat & onset lambat dan faktor risiko (-)

Patogen potensial
Streptococcus pneumoniae
Haemophilus influenza
Metisilin resisten staphylococus
aureus ( MRSA )
Gram negatif enterik
- E coli
- Klebsiella pneumonia
- Enterobacter sp
- Proteus spp
Kuman lain : Pseudomonas aeroginosa,
Acinetobacter spp

Antibiotika yg
direkomendasikan
Aminoglikosid dikombinasi dengan
salah satu dibawah ini :
@
@
@
@
@
@

Penisilin anti pseudomonas

Piperasilin + Tazobactam
Ceftasidin atau Cefoperazon
Imipenem
Meropenem
Cefepim

Pedoman Diagnosis & Penatalaksanaan Pneumonia Nosokomial PDPI 2005

Batuk
Darah

Efusi
PleuraEmpyema

Abses
Paru

Acut Lung
Injure

Komplikasi
Pneumonia
Gagal
Nafas

ARDS

Meninggal

SepsisSeptik
syok