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Last Updated: 3/5/2014  

Community Acquired Pneumonia

Prevention
  • Administer annual influenza vaccine to all adults.

  • Administer 23-valent pneumococcal vaccine to all patients over age 65 and to those under age 65 with certain chronic diseases or tobacco use; administer both 23-valent and 13-valent pneumococcal vaccines to immunocompromised patients.

Diagnosis
  • Look for symptoms of cough, fever, dyspnea, or deterioration of a chronic medical illness.

  • Examine the patient for fever and crackles, and measure oxygen saturation with pulse oximetry.

  • Obtain a chest x-ray for most outpatients and chest x-ray and blood cultures for inpatients.

Therapy
  • Treat outpatients with no cardiopulmonary disease and no modifying factors with a macrolide (azithromycin or clarithromycin) or doxycycline.

  • Treat outpatients with cardiopulmonary disease and/or modifying factors with either an antipneumococcal quinolone (levofloxacin or moxifloxacin) or a β-lactam (cefuroxime, cefpodoxime, amoxicillin/clavulanate) with a macrolide.

  • Treat inpatients with no cardiopulmonary disease and no modifying factors with an intravenous macrolide (azithromycin) alone.

  • Treat inpatients with cardiopulmonary disease and/or modifying factors with an intravenous antipneumococcal quinolone or an intravenous β-lactam with a macrolide.

  • Treat ICU patients with no risk factors for P. aeruginosa with an intravenous β-lactam plus either a macrolide or a quinolone.

  • Treat ICU patients with risk factors for P. aeruginosa with an intravenous antipseudomonal β-lactam (cefepime, piperacillin/tazobactam, imipenem, meropenem) plus an intravenous antipseudomonal quinolone (ciprofloxacin) or an intravenous antipseudomonal β-lactam with an aminoglycoside plus either an intravenous macrolide or an intravenous antipneumococcal quinolone.

  • Treat ICU patients with the addition of linezolid or clindamycin in combination with vancomycin if community-acquired MRSA is suspected.

DOI: 10.7326/d104
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Michael S. Niederman, MD is a consultant for Pfizer, Schering, Elan, Merck, Wyeth; received honoraria from consultancies from Pfizer, Schering, Elan, Merck, Wyeth. Michael S. Niederman, MD is a consultant for Pfizer, Schering, Elan, Merck, Wyeth; received honoraria from consultancies from Pfizer, Schering, Elan, Merck, Wyeth.
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
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