Risk factors for MRSA and PsA are prior isolation, and hospitalization with antibiotics in past 90 days.
Risk factors for MRSA and PsA are prior isolation, and hospitalization with antibiotics in past 60 days. Targets of empiric CAP therapy include S. pneumonia, H. influenzae, M. catarrahlis, L. pneumophila, and C. pneumoniae. Legionella and Chlamydia are considered atypical since they’re not easily detected on standard assays. Here’s a quick review of the ATS/IDSA 2019 CAP Guideline antibiotic recomendations.
High dose amoxicillin, thats 1000 mg po TID, has shown to be effective even without coverage for atypical pathogens. Doxycycline and macrolides cover common CAP pathogens, including atypicals. Monotherapy with one of these three can be considered in patients without comorbidities.
Patients with comborbidities are at higher risk for broader and emerging resistant organisms. These would include those with chronic organ disease, alcoholism, malignancy, and asplenia. Combination therapy is recommended with amoxicillin/cluvanate acid or a cephalsporin like cefuroxime and cefpodoxime, in addition to atypical coverage with doxycline or macrolide is recommended.
Patients requiring admission with CAP are treated initially with IV antibiotics. Beta-lactams and macrolide combination therapy is recommended. You’ll likely come across ceftriaxone and azithromycin.
Patients with risk factors for MRSA or Pseudomonas should add vancomycin and change the beta-lactam to piperacillin-tazobactam or cefepime, where appropriate. Did you share the #PHARMFAX? Check out another video on my page, and I hope you learned something new.
Recommended Read/Watch
IV/PO Antibiotics MRSA - https://www.instagram.com/p/Cthjg9qA_HW/
IV/PO Antibiotics PsA - https://www.instagram.com/p/CtQfaB7gJOj/
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References
Metlay et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med . 2019 Oct 1;200(7):e45-e67.
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