Antibiotic Therapy in Community-Acquired Pneumonia: Switch and Step Down Therapy

Tables

Table I - Factors Associated with Increased Morbidity and Mortality

• Post-splenectomy state

• Chronic alcohol abuse

• Altered mental status

• Vital sign abnormalities:

  • respiratory rate > 30

  • systolic BP < 90

  • diastolic BP < 60

  • temperature >101deg.F

• PaO2 < 60 mmHg

• PaCO2 > 50 mmHg

• Need for mechanical ventilation

• Metastatic (extrapulmonary) infection

  • WBC < 4,000 or > 30,000/mm³

  • Renal dysfunction, ie, BUN > 20mg/dL

  • Unfavorable chest radiographic pattern:

    • multilobar infiltrates

    • effusions

    • rapidly progressive infiltrates

    • cavitation

• Evidence of severe infection:

  • metabolic acidosis

  • DIC

  • Severe sepsis or septic shock

  • ARDS

Table II - Factors that Can Slow Pneumonia Resolution

• Increased age

• Alcohol abuse

• Significant coexisting medical disease

• Severe pneumonia

• Multilobar disease

• Infection with a virulent pathogen, ie, Legionella pneumophilia, S aureus, and gram-negative bacilli

• History of smoking

• Persistent leucocytosis and fever

• Bacteremic infection

Table III - Criteria Used in Identifying Step Down Therapy Candidates

• Improving cough

• Improving respiratory distress

• Absence of fever for > 24 hours

• Absence of high risk or resistant pathogens, ie, S aureus

• Absence of unstable coexisting medical disease

• Absence of complications, ie, congestive heart failure

• Intact gastrointestinal absorption

• Improving leucocytosis

Medscape General Medicine. 1998;1(3) © 1998 

Cite this: Antibiotic Therapy in Community-Acquired Pneumonia: Switch and Step Down Therapy - Medscape - May 01, 1998.