Pneumonia
(Community Acquired )
Pneumonia
(Community Acquired )
CXR or CT consistent with PNA
Community Acquired Pneumonia
Oxygen saturation > 89% on RA at time of admit to CDU
Initial dose of antibiotics given in ED
Vital signs are stable
Patient is ambulatory
Severe Sepsis (SIRS + Source + End Organ Damage. I.e. Encepahlopathy, AKI)
Potential respiratory failure
Multilobar PNA with negative viral testing (Multilobar Flu or COVID OK)
Unlikely to be discharged in 24 hours
Poor candidate for outpatient therapy
Immunocompromised patients: HIV/AIDS, Solid Organ Transplant, CVID, chemotherapy, chronic steroid use, active cancer, sickle cell disease, asplenia
High Risk Patients: Nursing home patient, cancer, cirrhosis, AMS, Nosocomial etiology, risk of aspiration PNA
Recent incarceration
Antibiotics
Ceftriaxone 1000 mg IV Q24 and Azithromycin 500 mg PO daily/Doxycycline 100 mg BID
Penicillin allergy still gets Ceftriaxone
If truly allergic to above regimen, can use Levofloxacin 750 mg PO Daily as long as QTC < 480
Breathing treatments scheduled and prn
Continuous pulse oximetry
Consider incentive spirometry
Oxygen NC PRN if saturation < 92%
Mucinex 600 mg one tablet Q12 hours
Tessalon 100mg PRN TID
Disposition
Subjective and clinical improvement during CDU stay
Oxygen saturation > 90% on RA or baseline O2
SBP > 100, RR <26, Pulse < 100
Patient able to tolerate oral medications and diet
Home health care follow up if needed
Can tolerate and pass a walk test
Discharge Meds
Cefuroxime 500 mg BID Or Amoxicillin 875 mg BID for total of 7 days
PLUS
Azithromycin 500 mg daily for total of 5 days or Doxycycline 100 mg BID for total of 7 days
If patient is truly allergic to both beta lactams and cephalosporins, fluoroquinolone monotherapy can be used (Levofloxacin 750 mg daily x 5 days) if no contraindications.
Patient not subjectively improved enough to go home
Lack of clinical progress or clinical deterioration
Unable to safely discharge patient for outpatient management
Physician discretion