24. Treatment of community-acquired and nosocomial pneumonia

Question 1

Treatment of Community-Acquired Pneumonia

Answer 1

• Decision to hospitalize based on severity of pneumonia and respiratory distress signs
• Outpatients younger than 60: Macrolides/Doxycycline; Fluoroquinolones
• Outpatients older than 60 with comorbidities: Levofloxacin/Moxifloxacin + Macrolide/Amoxicillin-Clavulanate
• Hospitalized patients: Fluoroquinolone alone OR 3rd gen cephalosporin + Macrolide

Outpatient treatment atleast 5 days until afebrile for 48 hours

Methylprednisone in patients with severe pneumonia and shock

Question 2

Treatment for Hospital-Acquired Pneumonia

Answer 2

Not high risk without risk factor for MRSA:
- Antipneumococcal, antipseudomonal Beta-lactam OR
- Levofloxacin

Not high risk with risk factor for MRSA:
- Linezolid/Vancomycin + Beta-lactam/Fluoroquinolone/Aztreonam

High risk for mortality with structural lung disease:
- Same as last one

Question 3

Treatment for Ventilator-associated Pneumonia

Answer 3

Combination therapy:
- Beta-lactam
- Linezolid/Vancomycin
- Fluoroquinolone/Aminoglycoside/Polymyxin B

7 days of therapy is usually sufficient
Consider for multi-drug resistant variants of pathogens