Differentiate between CAP and HCAP! Do not forget to ask the right questions such as last hospital admit, frequent prior multiple antibiotics.
Always differentiate to non-infectious etiologies:
-Cardiac: CHF
-Pulmonary: PE
-Auto-immune such as Wegner's granulomatosis, BOOP and allergic reactions
2-Investigations:
Send sputum for gram stain, cultures.
Consider Pneumococcal and legionella urine antigen for severe cases.
Consider CT Scan of Chest
3-Empirical antibiotic therapy:
Outpatient therapy:
For previously healthy and no risk factors for DRSP:
A- A Macrolide
B- Doxycycline
Presence of comorbid factors:
A- Fluoroquinolones
B- A beta-lactam plus macrolide (alternative doxycycline)
In regions with a high rate(>25%) of infection with a high-level macrolide resistant (MIC >16) Streptococcus pneumoniae, use alternatives.
Inpatient non-ICU admit:
A-A respiratory quinolone
B- A Beta-lactam plus macrolide (or doxycycline as alternative)
Inpatient ICU-admit:
- A beta-lactam plus either azithromycin (or Fluoroquinolone)
- Cover MRSA with Vancomycin or Linezolid if expecting an infected patient with influenza
