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The regimen below provides standard coverage for early onset (≤5 days) pathogens
Early Onset Pathogens
Ceftriaxone 2 G IV Q24h
WITH OR WITHOUT
Azithromycin 500mg IV/PO x 1
For atypical coverage
Continue if Legionella urinary antigen positive or if clinical suspicion high
OR
Doxycycline 100mg PO Q12h
If Azithromycin cannot be used
IF CRITICALLY ILL, ADD
Vancomycin 25 mg/kg IV OT as loading dose, THEN maintenance dose per PH Guidelines (consider pharmacy consult to dose)
D/C if MRSA nasal swab PCR is negative
Critical Illness
Intensive care unit admission
Need for mechanical ventilation or vasopressors
Other severe complications of pneumonia (e.g. empyema)
Consider transition to oral therapy once clinically improved/stable
Depending on causative pathogen, oral options may be even narrower-spectrum than those presented herein
Narrowest effective therapy is generally preferred to minimize adverse effects and emergence of resistance
Amoxicillin/Clavulanate 500mg/125mg PO Q8h
Azithromycin 500mg PO Q24h X 3 days
For atypical coverage, if still needed
If Azithromycin cannot be used and atypical coverage still needed
7 days
