Let’s imagine you’re seeing a case of pneumonia, and you suspect (as is quite reasonable these days) that it is precipitated by H1N1 influenza.
What antibiotics do you choose for an outpatient?
(If someone is sick enough to be admitted — especially to the ICU — I’m assuming the all-guns blazing approach will be adopted.)
Even though some of these pneumonias have been only H1N1, bacterial superinfection can and does occur — most commonly with our old friend S. pneumoniae, somewhat less so with group A strep, S. aureus (including MRSA, of course), and H. influenza.
But since we hardly ever know exactly what species of bacteria we’re dealing with, how can you leave even one of these out? That MRSA one in particular?
This past week I chose trimethoprim-sulfamethoxazole + high-dose levofloxacin — in addition to the oseltamavir.
Overkill? These guidelines from Canada would suggest so, but I’m not so sure. After all, most people with H1N1 do not get pneumonia at all (and hence do not need antibiotics), and not surprisingly this was not a person with a normal immune system.
Should be an interesting winter …