Community Acquired Pneumonia

Pneumonia EGF

It is certainly the season for pneumonias (even my little daughter had a significant one – see above)… and you will encounter community acquired pneumonia… so, let’s talk therapy.

Large Disclaimer – there is no perfect recommendation that can easily be made to encompass all patients. Tailor the therapy for the individual patient: that being said, here is are suggestions to get you started on the right path.

Questions to Answer for yourself:

1) Outpatient vs Inpatient

2) Typical vs Atypical

OUTPATIENT THERAPY:

  • < 5yrs
    • You suspect bacterial pneumonia
      • Amoxicillin (90mg/kg/Day div BID) or Augmentin (45mg/kg/Day div BID) {use TID for pneumoccoci that is more resistant to penicillins}
    • You suspect atypical pneumonia
      • Azithromycin (yes, even in this age group)
  • 5yrs and older
    • You suspect bacterial pneumonia
      • Amoxicillin as above
      • If you have evidence consistent with pneumococcal or atypical infection, then ADD a macrolide.
    • If you suspect an atypical pneumonia
      • Azithromycin

INPATIENT THERAPY:

  • Fully immunized and low local penicillin resistance
    • You suspect bacterial pneumonia
      • Ampicillin or Penicillin or
      • Ceftriaxone
      • Add Vancomycin if CA-MRSA is a concern
    • You suspect atypical pneumonia
      • Azithromycin
      • Add beta-lactam if your diagnosis is in doubt
  • Not fully immunized or with high local penicillin resistance
    • You suspect bacterial pneumonia
      • Ceftriaxone or Cefotaxime
      • Add Vancomycin if CA-MRSA is a concern
    • You suspect atypical pneumonia
      • Azithromycin
      • Add beta-lactam if you diagnosis is in doubt

 

Sean Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renown educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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