2017;12:CD007720). Consider in severe CAP (FiO2 >0.5 + ≥1 of: pH<7.

3; lactate >4; CRP

>150). Avoid in suspected or known influenza. Dosing: pred 50 mg PO ×7 d or

methylpred 0.5 mg/kg IV BID ×5 d.

Duration: for CAP, 5 d if stable & afebrile for 48–72 h; for HAP/VAP, 8 d (CID 2017; 65:8)

When possible, de-escalate abx based on sensitivities

Prognosis

For low-risk Pts, can discharge immediately after switching to PO abx (CID 2007;44:S27)

CXR resolves in most by 6 wk; consider f/u to r/o underlying malig (esp. if >50 y or

smoker)

Prevention

All persons >65: give PCV13 vaccine followed by PPSV23 vaccine 1 y later. If PPSV23

already received, give PCV13.

Age 19–64 w/ CHF/CMP, lung disease (including asthma), cirrhosis, DM, EtOH, or
smoker: give PPSV23.

Any age w/ immunocomp., CSF leak, cochlear implant, asplenia: give PCV13 followed by

PPSV23 8 wks later.

Smoking cessation counseling

VAP precautions: HOB >30°, chlorhexidine rinse; aspiration precautions in high-risk Pts