A 54-year-old man is evaluated in the hospital on the third day of his admission for community-acquired pneumonia. He was initially started on empiric therapy with intravenous ceftriaxone and azithromycin. Today, the patient reports feeling much better and has a good appetite. His temperature is 37.1°C (98.8°F), blood pressure is 124/78 mm Hg, pulse is 76/min, and respiratory rate is 16/min. He is tolerating a regular diet. Blood cultures drawn on admission are negative. Sputum cultures have grown *Streptococcus pneumoniae*. Susceptibility testing indicates the isolate is sensitive to penicillin, amoxicillin, levofloxacin, and vancomycin. Which of the following is the most appropriate next step in this patient's management?
- ATransition to oral amoxicillin-clavulanate
- BTransition to oral levofloxacin
- Transition to oral amoxicillinAnswer
- DContinue intravenous ceftriaxone and azithromycin
- EDiscontinue all antimicrobial therapy and observe
Answer
Transition to oral amoxicillin
The correct choice is transitioning to oral amoxicillin. This patient is clinically stable, afebrile, and tolerating oral intake, making him an excellent candidate for the transition from intravenous to oral antibiotics. Furthermore, culture results show Streptococcus pneumoniae susceptible to amoxicillin. Principles of antimicrobial stewardship dictate narrowing the antibiotic spectrum to the most targeted, effective agent available once susceptibilities are known. Oral amoxicillin is the most appropriate narrow-spectrum choice that minimizes collateral damage to the normal flora.
Step-by-Step Solution
Key Concept
In clinically stable hospitalized patients with resolving community-acquired pneumonia, empiric broad-spectrum intravenous antibiotics should be transitioned to targeted, narrow-spectrum oral antibiotics based on culture and susceptibility data.
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