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