CAP

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Community-Acquired Pneumonia (CAP)

Indications

  • PNA within 48 hours of hospital admission
  • PNA in patient lacking predictors for MDR organisms
  • Indications to add MRSA coverage
    • Post-influenza PNA
    • Necrotizing PNA
    • Known colonization with MRSA

First line treatment

  • Ceftriaxone 2g IV plus
    • Azithromycin 500mg IV daily
      or
    • Levofloxacin 750mg IV or oral daily
  • With MRSA risk factors, add Vancomycin 15mg/kg IV every 12 hours*
  • De-escalate once sensitivities are available

Penicillin alternative

  • Levofloxacin 750 mg IV or oral daily plus Aztreonam 2g IV every 8 hours for 5-7 days
  • With MRSA risk factors, add Vancomycin 15mg/kg IV every 12 hours*
  • De-escalate once sensitivities are available

Duration

  • 5-7 days
  • Based on clinical response, with rapid clinical response, it is reasonable to give a 5-day course (should be afebrile for 48 hours); treat for full 7 days for continued critical illness.

Notes

When to transition to oral: When hemodynamically stable and clinically improving.

*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.

 

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.