Patients age > 50 years have a decreased likelihood of pneumonia from Mycoplasma pneumoniae, Chlamydophila pneumoniae. (Anti-infective Review Panel guidelines, 2013)

• There is a low level of resistance of Streptococcus pneumoniae to amoxicillin in PEI
• In non-central nervous system infections, Streptococcus pneumoniae has 100% susceptibility to high dose amoxicillin (1 g PO TID) and is susceptible to low dose amoxicillin in 82% of isolates
• Susceptibility of Streptococcus pneumoniae to macrolides is only 74%
• The antibiogram may over-estimate resistance in the outpatient setting as sputum testing is not frequently done in this setting

• Fluoroquinolones should be reserved for sicker patients, patients who had treatment failure with an antibiotic from a different class, or those who cannot tolerate first-line therapy due to an antibiotic allergy.
• Concerns with wide spread use of fluoroquinolones include: unnecessary use of an agent with broad-spectrum of activity, development of fluoroquinolone resistance, and Clostridium difficile infection.
• Moxifloxacin carries the highest C. diff risk.