CAP

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CAP with Pseudomonas Infection Risk Factors

CAP with any of the following comorbidities:

  • COPD and/or smoking
  • Structural lung disease (bronchiectasis, cystic fibrosis, etc.)
  • Greater than 10mg Prednisone per day
  • Malnutrition
  • Compromised immune system
  • Recent prior antibiotic use

First line treatment

  • Cefepime 2mg IV every 8 hours plus Azithromycin 500 IV daily
  • With MRSA risk factors*, add  Vancomycin15mg/kg IV every 12 hours**

Duration

  • 5-7 days
  • Notes on duration: Based on clinical response. Rapid clinical response is reasonable to give 5-day course (should be afebrile for 48 hours); Treat for full 7 days for continued critical illness.

Notes

IDSA guidelines do not support longer courses of antibiotics, even for (previously recommended) non-glucose-fermenting gram-negative bacilli. 

*MRSA risk factors:

  • Post-influenza PNA
  • Necrotizing PNA
  • Known colonization with MRSA

**For any toxic patient, consider a Vancomycin loading dose of 25 mg/kg followed by 15 mg/kg every 12 hours. Every Vancomycin order requires pharmacokinetic consult.

Transition to oral: When hemodynamically stable and clinically improving.

 

Disclaimer: The contents of this application are for the exclusive and specific use of University of Mississippi Medical Center faculty and trainees. Any other use is neither authorized nor sanctioned by UMMC. The information is for educational purposes only. The contents of this application are for the exclusive and specific use of UMMC faculty and trainees. Any other use is neither authorized nor sanctioned by UMMC. The information is for educational purposes only.