Pneumonia (main): Difference between revisions
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==Treatment== | ==Treatment== | ||
* Abx within 6 hours | * Abx within 6 hours | ||
* 10-14 days | ** 10-14 days | ||
===Outpatient=== | ===Outpatient=== | ||
#Healthly | #Healthly | ||
## Macrolide OR doxycycline | ## Macrolide OR doxycycline | ||
# | #Unhealthy | ||
## Respiratory fluoroquinolone alone OR macrolide + beta-lactam | |||
===Inpatient=== | |||
# Ward | |||
## Respiratory fluoroquinolone alone OR macrolide + beta-lactam | |||
#ICU, low risk of pseudomonas | |||
## Beta-lactam + (macrolide OR respiratory fluoroquinolone) | |||
#ICU, risk of pseudomonas | |||
## Cefipime, imipenem, OR piperacillin-tazobactam + IV cipro/levo, OR | |||
## Cefipime, imipenem, OR piperacillin-tazobactam + gent + azithromycin, OR | |||
## Cefipime, imipenem, OR piperacillin-tazobactam + gent + cipro/levo | |||
===Pseudomonas risk factors=== | ===Pseudomonas risk factors=== | ||
Line 55: | Line 50: | ||
==Disposition== | ==Disposition== | ||
See Pneumonia (Port Score) | See [[Pneumonia (Port Score)]] | ||
==See Also== | ==See Also== | ||
Pneumonia (Pathogens) | [[Pneumonia (Pathogens)]] | ||
==Source== | ==Source== | ||
UpToDate | UpToDate | ||
[[Category:ID]] | |||
[[Category:Pulm]] | [[Category:Pulm]] |
Revision as of 18:43, 10 June 2011
Background
3 questions:
- Does this pt have pneumonia
- If yes, does this pt need to be admitted
- If yes, admit to the ward or ICU?
Clinical Presentation
- Fever, chills, pleuritic CP, productive cough
- Fever is seen in 80%
- Tachypnea
- Most sensitive sign in elderly
Work-Up
- CXR
- CBC
- Chemistry
If pt to be admitted:
- Blood cultures (required if pt may require ICU during their course)
- Sputum staining
- If concern for particular organism
Treatment
- Abx within 6 hours
- 10-14 days
Outpatient
- Healthly
- Macrolide OR doxycycline
- Unhealthy
- Respiratory fluoroquinolone alone OR macrolide + beta-lactam
Inpatient
- Ward
- Respiratory fluoroquinolone alone OR macrolide + beta-lactam
- ICU, low risk of pseudomonas
- Beta-lactam + (macrolide OR respiratory fluoroquinolone)
- ICU, risk of pseudomonas
- Cefipime, imipenem, OR piperacillin-tazobactam + IV cipro/levo, OR
- Cefipime, imipenem, OR piperacillin-tazobactam + gent + azithromycin, OR
- Cefipime, imipenem, OR piperacillin-tazobactam + gent + cipro/levo
Pseudomonas risk factors
- Alcoholism
- Immunosuppression (incl. steroids)
- Structural lung disease
- Malnutrition
- Recent abx
- Recent hospital stay
Disposition
See Also
Source
UpToDate