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TABLE 4

Management of Worsening or Lack of Improvement at 72 Hours

Initial ManagementWorse in 72 HoursLack of Improvement in 72 Hours
Observation Initiate amoxicillin with or without clavulanate Additional observation or initiate antibiotic based on shared decision-making 
Amoxicillin High-dose amoxicillin-clavulanate Additional observation or high-dose amoxicillin-clavulanate based on shared decision-making 
High-dose amoxicillin-clavulanate Clindamycina and cefixime OR linezolid and cefixime OR levofloxacin Continued high-dose amoxicillin-clavulanate OR clindamycina and cefixime OR linezolid and cefixime OR levofloxacin 
Initial ManagementWorse in 72 HoursLack of Improvement in 72 Hours
Observation Initiate amoxicillin with or without clavulanate Additional observation or initiate antibiotic based on shared decision-making 
Amoxicillin High-dose amoxicillin-clavulanate Additional observation or high-dose amoxicillin-clavulanate based on shared decision-making 
High-dose amoxicillin-clavulanate Clindamycina and cefixime OR linezolid and cefixime OR levofloxacin Continued 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.

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