Management of Community and Hospital Acquired Pneumonia



P & T Committee Update:

Lincoln Medical and Mental Health Center

Revised Guidelines for The Treatment of Pneumonia

JULY, 2007

Approved by: Pharmacy and Therapeutics Committee, Department of Infectious Diseases, Emergency Department, Department of Internal Medicine, and the

Department of Critical Care

NO NO

References:

1. ATS guidelines for the management of adults with hospital-acquired, ventilator associated pneumonia. Am J Respir Crit Care Med 2005; 171: 388-416.

2. Mandell LA, Bartlett JG, Dowell SF, etal. IDSA update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin infect dis 2003;37:1405-33.

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Risk Factors Present

No Risk Factors

ICU Patients

Non-ICU Patients

Antibiotic Therapy

Respiratory Quinolone – Avelox

OR

Doxycycline + Ceftriaxone (1-2g once daily)

Penicillin allergy

Avelox

Antibiotic Therapy

Azithromycin + Ceftriaxone (1-2g once daily)

OR

Avelox + Ceftriaxone (1-2g once daily)

Penicillin allergy

Avelox + Clindamycin

Antibiotic Therapy

Zosyn OR Cefepime + Cipro

Zosyn OR Cefepime + Avelox + Aminoglycoside

(Call Infectious Diseases for approval, except for first dose in ED.)

Penicillin allergy

Aztreonam + Avelox + Aminoglycoside

OR

Aztreonam + Clindamycin + Cipro

Non-ICU Patients

ICU Patients

Assess risk factors for multi-drug resistant pathogens

(Pseudomonas, E. coli, Klebsiella, Acinetobacter)

Broad spectrum antibiotic therapy > 7 days in the past month

Chronic Corticosteroid therapy, > 10mg of prednisone per day

Diagnosis or suspicion of bronchiectasis

Nursing home resident

Home infusion therapy

Home wound care

Chronic dialysis within 30 days

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