Treatment-pneumonia

• CAP (outPt)
  • Amoxicillin, azithro, or doxy (avoid latter two if >25% resistance locally)
• CAP (ward)
  • [3rd-gen ceph + azithro] or levoflox; omadacycline ≈ FQ (NEJM 2019;380:517)
• CAP (ICU)
  • 3rd-gen ceph + azithro.
  • Only cover MRSA or Pseudomonas if risk factors (prior PsA PNA, MRSA infection, recent hospitalization, IV abx)
• HAP/VAP
  • [Pip-tazo or cefepime or carbapen.] + [vanc or linezolid].
  • May add resp FQ or azithro if concerned for atypicals. Daptomycin not active in lungs.
• Treatment of empyema abscess

Rules

• Avoid quinolones if suspect TB.
  • When possible, de-escalate abx based on sensitivities.
• Steroids:
  • not unless indicated for shock or COPD exacerbation;
  • may ↓ mortality, mech vent, & ARDS in severe CAP (Cochrane 2017;12:CD007720).
  • avoid steroids in influenza
• Duration:
  • CAP: 5–7 days,
  • can de-escalate IV abx to PO after clinical improvement.
  • HAP/VAP: 7 days.
  • Empyema/abscess: 2–6 wks based on complexity, drainage.