+ Collect sputum and blood cultures (in pneumonia) ‘© Consult chest physician and/or microbiologist ‘+ Always consider prior therapy: patients who have not responded to a certain antimicrobial should receive an alternative from a different class. + Change to oral therapy 48 hours after resolution of fever and satisfactory clinical response ‘Antimicrobial agent te | = D056, route and duration — pete oy (Gitarnstda tor panics’ allergic patients) NEE CTV EXACERBATION OF 50% infections are LEVOFLOXACIN oral or Most universal CHRONIC OBSTRUCTIVE viral pole DOXYCYCLINE oral ‘gui PULMONARY DISEASE (COPD) ‘Streptococcus Give CEFUROXIME IV recommend oral \premnontes (LEVOFLOXACIN IV) in severe antimicrobials Haemophilus ‘cases (febrile, high peripheral wherever possible influenzae WBC count, ITU admission, etc.) Morexella catarrhalis MILD COMMUNITY ACQUIRED ‘Streptococcus ‘AMOXICILLIN + Levofloxacin PNEUMONIA (CAP) pneumoniae CLARITHROMYCIN oral monotherapy is Haemophilus Give IV initially only in the more shorter in duration influenzae severe cases of therapy and Atypical organisms, (LEVOFLOXACIN monotherapy economical, too. e.g., Mycoplasma in penicillin allergy) ppneumenioe Chlamydia ppneumenioe - _ CChiamyata psttact SEVERE COMMUNITY ACQUIRED As above + 70% years: CCAP is defined as PNEUMONIA (CAP) see notes for Legionella (LEVOFLOXACIN + severe if 22 of the assessment of severty ceeumontuios ——-ELARETHROMYCIN Vit following are Adeitional features e.g. age, co eee penicilin allergy) present. existing csease, nypocslcemia SaQ, yreus (post AMOXICILLIN + = Respiratory rate > '<92% or PaO <8KPa should also be considered. Influenza infection) ‘CLARITHROMYCIN IV <70 years or 70+ and 30/min - BP systolic <90, Unsatisfactory response at 48 a fours: CEFUROXIME Danke CLARITHROMYCIN IV REMEMBER: = *1f confirmed Legionella = Urea > 7 mMol/L Most Universal infection, consider aading sues guidelines RIFAMPICIN 600mg Iv 12 consoldation or recommend oral hourly Eavitation on CXR antimicrobials | *»1¢ confirmed ‘Staphylococcal + Confusion (AMT wherever possible pneumonia use <8) FLUCLOXACILLIN 2 grams IV G hourly + GENTAMICIN MILD TO MODERATE HOSPITAL —_ Streptococcus Mild: CO-AMOXICLAV + Most Universal ACQUIRED ppneumenioe CIPROFLOXACIN oral ‘guidelines or Staphylococcus or CEFIXIME + Fecommend oral ASPIRATION PAGDMONED aureus METRONIDAZOLE oral antimicrobials Coliforms and Moderate: CEFTRIAXONE + wherever possible anaerobes METRONIDAZOLE IV | (LEVOFLOXACIN + Use of Levofloxacin METRONIDAZOLE oral or 1vit__ makes therapy penicilin allergy) ‘economical SEVERE HOSPITAL ACQUIRED, Streptococcus.‘ TAZOCIN + GENTAMICIN +/- Recent studios VENTILATOR ASSOCIATED or Preumoniae METRONIDAZOLE have started looking ASPIRATION PNEUMONIA Staphylococcus (VANCOMYCIN + atuse of Levofloxacin aureus GENTAMICIN + aches (GENERALLY REQUIRING ICU caer METRONIDAZOLE if peniclin ADMISSION) anaerobes allergy)Collect sputum and biood cultures (in pneumonia) Consult chest physician and/or microbiologist ‘Always consider prior therapy: patients who have not responded to a certain antimicrobial should receive an alternative from a different class. Change to oral therapy 48 hours after resolution of fever and satisfactory clinical response verity) Duration of treatment = 14 days ACUTE INFECTION IN CYSTIC Stephylococeus Refer urgently to pulmonologist Eons) es for regular investigations and Pseudomonas ‘monitoring aeruginosa Pseudomonas cepacea SUSPECTED MDR TUBERCULOSIS — ycobacter'um Category IV anti-TB treatment Now, recommended in "ae eee Society & American ‘Journal of Respiratory Critical Care Medicine