CAP-HIGH RISK: FIRST LINE THERAPY

Non-pseudomonal Beta-lactam
HISTORY antibiotic
HISTORY of COUGH within the past 24 Ampicillin-sulbactam 1.5–3 g
hours or less than 2 weeks IV every 6 h
Unstable decompensated comorbid OR
condition Cefotaxime 1–2 g IV every 8 h
UNCONTROLLED DIABETES OR
MELLITUS Ceftriaxone 1–2 g IV daily
ACTIVE MALIGNANCIES PLUS
Macrolide
NEUROLOGIC DISEASE IN
EVOLUTION Azithromycin 500 mg PO/IV
CONGESTIVE HEART daily
OR
FAILURE (CHF) CLASS II-IV
Erythromycin 500 mg PO
UNSTABLE CORONARY
every 6 hours
ARTERY DISEASE
OR
(+) with suspected aspiration
Clarithromycin 500 mg PO
(+/-) Severe sepsis and Septic shock twice daily

PHYSICAL EXAM ALTERNATIVE THERAPY

Abnormal VITAL SIGNS: Non-pseudomonal Beta-lactam
Tachypnea (RR >30/min) antibiotic
PLUS
Tachycardia (HR>125/min)
Respiratory fluoroquinolone*
Fever (Temp>37.8)
Levofloxacin 750 mg PO/IV daily
SBP <90 mmHg
OR
DBP ≤60 mmHg Moxifloxacin 400 mg PO/IV daily
Temp ≤36 °C or ≥40 °C * given as 1 hour IV infusion
(+) Altered mental state of
acute onset
One ABNORMAL CHEST FINDINGS:
DIMINISHED BREATH
SOUNDS
RHONCHI
CRACKLES
WHEEZES
DIAGNOSTICS:
CXR
BLOOD CULTURE
GS/CS (RESPIRATORY SPECIMEN)
ABG
*NO Improvement after 72 hours of treatment, patient
should be reassessed for possible resistance to the
antibiotics or “for presence of other pathogens such as
M. tuberculosis, viruses, parasites or fungi”

MANAGEMENT:
(-/+) need for mechanical ventilator

LENGTH OF STAY
> 4 days confinement, at least 3 days
IV antibiotics

The following antibiotics should be started for empiric

treatment of patients with high risk CAP without MDRO
infection: