Management: Empiric Treatment

Empiric treatment
As soon as possible after diagnosis (Max: 4H)
Low Risk:
Without comorbid illness: Amoxicillin
With stable comorbid illness: B-lactam + B-lactamase inhibitor combinations
(BLIC) OR 2nd generation cephalosporins with or without extended macrolides
Moderate Risk:
Combination of IV non-antipseudomonal B-lactam WITH either an extended
macrolide or a respiratory fluoroquinoline
Management: Empiric Treatment
High-risk without risk for Pseudomonas aeruginosa:
IV non-antipseudomonal B-lactam (BLIC, cephalosphorin, or carbapenem) + IV
extended macrolide OR an IV respiratory fluoroquinolone
High-risk with risk for P. aeruginosa
IV antipneumococcal, antipseudomonal B-lactam (BLIC, cephalosphorin, or
carbapenem) + extended macrolide and aminoglycoside OR IV ciprofloxacin or
high dose IV levofloxacin
Management
Response:
Vital signs, sensorium, O2 Sat, and
inspired oxygen concentation
Expected within 24-72 hours
De-escalation from broad-
spectrum or combination therapy
Based on laboratory data
Once clinically improving,
hemodynamically stable, and has
functioning GIT
Management
Duration of treatment:
Low-risk: 5-7 days
Moderate-risk: 7-10 days
Moderate/High-risk with bacteremia:
28 days
Discontinuation
Afebrile for 48-72 hours with no signs
of clinical instability
Management
If not improving after 72 hours:
Complete reappraisal
Hx, PE, resistance, additional
pathogens
Follow-up chest radiograph
Additional specimen
Management
Discharge:
Once clinically stable and oral
therapy is initiated
Repeat CXR not needed
Repeat CXR recommended on
follow-up after 4-6 weeks
Prognosis & Education
1 week: fever should have resolved
4 weeks: chest pain and sputum production should have substantially
been reduced
6 weeks: cough and breathlessness should have substantially been
reduced
3 months: most symptoms should have resolved but fatigue may still
be present
6 months: most people will feel back to normal