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Antimicrobials
Negative diagnostics for atypical bacteria
If diagnostics for atypical bacteria are negative (e.g. atypical bacteria on the Respiratory Viral PCR panel, Legionella urinary antigen), consider discontinuing atypical coverage altogether
Legionella highly suspected
This includes recent outbreak or classic clinical and laboratory manifestations for Legionella pneumonia (e.g. high fever, severe hypoxia, hyponatremia, elevated liver enzymes).
Consider levofloxacin or azithromycin over doxycycline as atypical coverage
The recommended duration of azithromycin therapy varies based on dosage and is often shorter than a concomitant beta-lactam antibiotic agent
Azithromycin 500mg IV/PO Q24h x total 3 days
OR
Azithromycin 500mg IV/PO x 1days, THEN 250 mg IV/PO Q24h x 4 days (x total 5 days)
Duration of azithromycin therapy may be extended to total 10-14 days, particularly for cases of severe illness and/or slow clinical improvement
