Treatment approach.
Describe the criteria for hospitalization.
Every patient should be assessed individually and clinical judgment is the most important factor. The pneumonia severity index (PSI) and the CURB-65 score are tools that can help to determine whether to admit a patient.
CURB-65 score
Confusion (disorientation, impaired consciousness)
Serum Urea > 7 mmol/L (20 mg/dL)
Respiratory rate ≥ 30/min
Blood pressure: systolic BP ≤ 90 mm Hg or diastolic BP ≤ 60 mm Hg
Age ≥ 65 years
Interpretation
Each finding is assigned 1 point.
CURB-65 score 0 or 1: The patient may be treated as an outpatient.
CURB-65 score ≥ 2: Hospitalization is indicated.
CURB-65 score ≥ 3: Consider ICU level of care.
List criteria for ICU admission.
The decision of whether to admit a patient to the ICU should be based on clinical judgment.
The IDSA/ATS criteria for severe CAP can be used to help triage patients with CAP and guide empiric antibiotic treatment decisions.
Empiric antibiotic therapy for community aquired pneumonia: outpatient-setting (table).
Describe the duration of treatment for community-acquired pneumonia: outpatient-setting.
5 days of therapy is usually sufficient for CAP that is treated in the outpatient setting.
Any patient being treated in a primary care setting should be re-examined after 48–72 hours to evaluate the efficacy of the prescribed antibiotic.
Describe the empiric AB treatment in an inpatient setting (community-acquired).
Describe the empiric AB treatment in an inpatient setting (hospital-acquired).
Describe the empiric AB treatment in an inpatient setting (ventilator-associated).
An antipneumococcal, antipseudomonal β-lactam
Aztreonam
Imipenem
Meropenem
Ceftazidime
Cefepime
Piperacillin-tazobactam
PLUS one of the following antibiotics with MRSA activity:
Vancomycin
Linezolid
PLUS one of the following:
A fluoroquinolone
Levofloxacin
Ciprofloxacin
An aminoglycoside
Amikacin
Gentamicin
Tobramycin
A polymyxin
Colistin
Polymyxin B
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