Table. 2—

Summary of antibiotic recommendations^#

Setting	LRTI type	Severity/sub-group	Treatment
Setting	LRTI type	Severity/sub-group	Preferred	Alternative^¶
Community	LRTI⁺	All	Amoxicillin or tetracyclines^§	Co-amoxiclav, macrolide^ƒ, levofloxacin, moxifloxacin
Hospital	COPD⁺	Mild	Amoxicillin or tetracyclines^§	Co-amoxiclav, macrolide^ƒ, levofloxacin, moxifloxacin
Hospital	COPD	Moderate/severe	Co-amoxiclav	levofloxacin, moxifloxacin
Hospital	COPD	Plus risk factors for P. aeruginosa	Ciprofloxacin
Hospital	CAP	Nonsevere	Penicillin G±macrolide^ƒ; aminopenicillin±macrolide^ƒ; co-amoxiclav±macrolide^ƒ; 2nd or 3rd cephalosporin±macrolide^ƒ	levofloxacin, moxifloxacin
Hospital	CAP	Severe	3rd Cephalosporin + macrolide^ƒ	3rd Cephalosporin + (levofloxacin or moxifloxacin)
Hospital	CAP	Severe and risk factors for P. aeruginosa	Anti-pseudomonal cephalosporin + ciprofloxacin	Acylureidopenpenicillin/β-lactamase inhibitor + ciprofloxacin or
				Carbapenem + ciprofloxacin
Hospital	Bronchiectasis	No risk factors for P. aeruginosa	Amoxicillin clavulanate, levofloxacin, moxifloxacin
		Risk factors for P. aeruginosa	Ciprofloxacin

LRTI: lower respiratory tract infection; COPD: chronic obstructive pulmonary disease; CAP: community-acquired pneumonia; P. aeruginosa: Pseudomonas aeurginosa. ^#: see introductory paragraphs for derivation of terms used; ^¶: to be used in the presence of hypersensitivity to preferred drug or widespread prevalence of clinically relevant resistance in the population being treated. In some European countries only “alternatives” will be used; ⁺: antibiotic therapy may not be required (see text for indications for antibiotic therapy); ^§: tetracycline or doxycycline; ^ƒ: erythromycin, clarithromycin, roxithromycin or azithromycin. Telithromycin may be an alternative for consideration in the community or in hospitals for COPD exacerbation or CAP. However, clinical experience with this antibiotic is currently too limited to make specific recommendations. Oral cephalosporins are generally not recommended due to poor pharmacokinetics. For recommended dosages see Appendix 3.