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Pneumonia ManagementAka: Community Acquired Pneumonia Management

See Also
Management: Children
1. See Pneumonia Management in Children
Management: General Measures
1. Early mobilization
  1. Sitting up for >20 minutes on first hospital day
  2. Mundy (2003) Chest 124:883
2. Start antibiotic within 4 hours of hospitalization
  1. Decreases mortality
  2. Decreases length of stay
  3. Houck (2004) Arch Intern Med 164:637
3. Determine if hospitalization needed
  1. See Pneumonia Hospitalization Criteria
  2. Pneumonia Hospitalization Criteria in the Elderly
4. Be aware of Antibiotic Resistance
  1. See Streptococcus Pneumoniae resistance
  2. Reserve use of Fluoroquinolones to prevent resistance
5. Course of antibiotics
  1. Course of 10 days
    1. Streptococcus Pneumoniae
  2. Course of 10-14 days
    1. Mycoplasma pneumoniae
    2. Chlamydia pneumoniae
Management: Outpatient in adults aged 18 to 65 years
1. First line agents for community acquired Pneumonia
  1. Doxycycline
  2. Macrolide antibiotics
    1. Azithromycin
    2. Clarithromycin
  3. Fluoroquinolones (reserve for more severe cases)
    1. Levofloxacin
    2. Gatifloxacin
    3. Grepafloxacin
    4. Moxifloxacin
    5. Sparfloxacin
2. Alternative agents for community acquired Pneumonia
  1. Amoxicillin-Clavulanate (Augmentin)
  2. Cephalosporins
    1. Cefpodoxime (Vantin)
    2. Cefprozil (Cefzil)
    3. Cefuroxime (Cefzil)
    4. Cefdinir (Omnicef)
Management: Inpatient Management in adults age >18 years
1. See inpatient indications as above
2. Criteria to switch to oral antibiotics
  1. Temperature <100.0 F (37.8 C)
  2. Heart Rate <100 beats per minute
  3. Respiratory Rate <24 breaths per minute
  4. Systolic Blood Pressure >90 mmHg
  5. Oxygen Saturation >90%
3. Single agent: Broad spectrum Fluoroquinolone
  1. Levofloxacin
  2. Gatifloxacin
  3. Grepafloxacin
  4. Moxifloxacin
  5. Sparfloxacin
4. Combination
  1. General
    1. Cephalosporin with Macrolide offers best outcomes
    2. Brown (2003) Chest 123:1503
  2. Antibiotic 1
    1. Third generation Cephalosporin
      1. Cefotaxime (Claforan)
      2. Ceftriaxone (Rocephin)
    2. Broad spectrum Penicillin
      1. Ampicillin-Sulbactam (Unasyn)
      2. Ticarcillin-clavulanate (Timentin)
      3. Piperacillin-Tazobactam (Zosyn)
  3. Antibiotic 2: Macrolide
    1. Erythromycin
    2. Azithromycin 500 mg IV (especially ICU patient)
References
1. Gilbert (2001) Sanford Antimicrobial, p. 27
2. Bartlett (1998) Clin Infect Dis 26:811
3. Bartlett (2000) Clin Infect Dis 31:347
4. King (1997) Am Fam Physician 56:544
5. Lutfiyya (2006) Am Fam Physician 73:442
6. Niederman (1993) Am Rev Respir Dis 148:1418
7. Thibodeau (2004) Am Fam Physician 69:1699

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.