By vgreene, 27 March, 2020 Not recommended. Corticosteroids not recommended in CAP (except in severe COVID-19),5,6 influenza,3 influenza;3 if aspiration suspected, don't routinely add anaerobic coverage unless lung abscess/empyema suspected3
By vgreene, 27 March, 2020 Remdesivir granted EUA for severe dz dz (SpO2 ≤94% on RA, or on supp O2, vent or ECMO) in hospitalized adults; don’t use for mild to moderate dz outside of clinical trials, per NIH5
By vgreene, 27 March, 2020 If influenza suspected or test start antiviral w in 48h of sx onset per ACCP 4 ATS IDSA suggests flu tx for CAP pts w flu test regardless of sx duration 3 If flu test in CAP w CXR Empiric antibacterials should still be used
By vgreene, 27 March, 2020 If Pseudomonas infection risk 3 If severe CAP or previous Pseudomonas isolate hx add piperacillin tazobactam cefepime ceftazidime aztreonam meropenem or imipenem based on limited evidence consider de escalating at 48h based on cx results Otherwise withhol
By vgreene, 27 March, 2020 If MRSA risk 3 If severe CAP or previous MRSA isolate hx add vancomycin or linezolid based on limited evidence consider de escalating at 48h based on cx nasal PCR results If nonsevere CAP w o previous isolate hx withhold until if cx and or nasal PCR resul
By vgreene, 27 March, 2020 If severe CAP combo tx w 1 of these ampicillin sulbactam cefotaxime ceftaroline ceftriaxone PLUS 1 of these azithromycin clarithromycin levofloxacin moxifloxacin 3
By vgreene, 27 March, 2020 If nonsevere CAP combo tx w 1 of these ampicillin sulbactam cefotaxime ceftaroline ceftriaxone PLUS azithromycin or clarithromycin Or use mono tx w levofloxacin or moxifloxacin 3 If both macrolides and fluoroquinolones contraindicated could combine lactam
By vgreene, 27 March, 2020 Abx duration until stabilized for 5 days 3 Stabilized T HR RR BP SpO2 eating mentation all NL
By vgreene, 27 March, 2020 Pre tx blood sputum cx for severe CAP esp if intubated treat pts empirically for MRSA or P aeruginosa so abx can be de escalated if cx Conditionally recommended in pts previously infected w MRSA or P aeruginosa as well as pts exposed in past 90 days to ho
By vgreene, 27 March, 2020 Start empiric antimicrobials if imaging or if imaging not available but CAP suspected Use antibacterials even if flu test in CAP 3