Management of Worsening or Lack of Improvement at 72 Hours

Initial ManagementWorse in 72 HoursLack of Improvement in 72 Hours
ObservationInitiate amoxicillin with or without clavulanateAdditional observation or initiate antibiotic based on shared decision-making
AmoxicillinHigh-dose amoxicillin-clavulanateAdditional observation or high-dose amoxicillin-clavulanate based on shared decision-making
High-dose amoxicillin-clavulanateClindamycina and cefixime OR linezolid and cefixime OR levofloxacinContinued high-dose amoxicillin-clavulanate OR clindamycina and cefixime OR linezolid and cefixime OR levofloxacin
  • a Clindamycin is recommended to cover penicillin-resistant S pneumoniae. Some communities have high levels of clindamycin-resistant S pneumoniae. In these communities, linezolid is preferred.