By vgreene, 27 March, 2020 If hi-risk comorbidity1 or MSRA/Pseudomonas risk: Combo tx w/ 1 of these: amoxicillin/clavulanate, cefpodoxime, cefuroxime PLUS 1 of these: azithromycin, clarithromycin, doxycycline. Or use mono-tx w/ levofloxacin, moxifloxacin, or gemifloxacin1
By vgreene, 27 March, 2020 If no hi-risk comorbidity1/MRSA/Pseudomonas risk:1 amoxicillin, doxycycline; macrolides OK if local resistance
By vgreene, 27 March, 2020 Test early for COVID 19 in pts w fever cough dyspnea 1 consider flu 1 4 other coinfections 2 Absence of imaging shouldn t delay empiric tx 3
By vgreene, 27 March, 2020 Not recommended routine sputum Gram stain cx3 except in certain4 hospitalized pts e g severe intubated tx for MRSA P aeruginosa infection prior hospitalization w in 90 days procalcitonin level 3 4 pneumococcal urine antigen 4
By vgreene, 27 March, 2020 CRP can strengthen dx exclusion per ACCP 3 though evidence low CRP 30 mg L w suggestive s sx CAP likely cause of acute cough CAP less likely if CRP
By vgreene, 27 March, 2020 Legionella urine test if severe CAP or if local outbreak or travel related 4
By vgreene, 27 March, 2020 Influenza rapid NAAT test4 w prompt tx w in 48h recommended vs RIDT when flu circulating 3 4 May consider testing pts w ILI during periods of low flu activity 4
By vgreene, 27 March, 2020 Use nasopharyngeal swab PCR NAAT more reliable than antigen tests Follow algorithm5 for antigen testing most POC tests o Symptomatic If antigen test positive isolate and treat as appropriate If antigen test negative repeat in 48h or perform PCR NAAT If 2n
By vgreene, 27 March, 2020 Prioritize COVID-19 test. High priority: inpt; symptomatic healthcare worker/1st responder/congregate living setting worker; symptomatic pt in long-term care facility (incl prison, shelter); public health cluster/contact investigations. Priority: pts w/ C