CAP Empiric Treatment

Treatment Options

Low Risk or Outpatient (i.e. CRB-65 score = 0)

  • amoxicillin 1g PO TID
  • amoxicillin-clavulanate 875/125mg PO BID

Duration:  5 days

High risk or Inpatient (i.e. CRB-65 score = 1-4)

  • PO example:  amoxicillin 1g TID  OR amoxicillin/clavulanate 875mg/125mg BID +/- doxycycline 100mg BID
  • IV example:  ceftriaxone 1g q24h +/- doxycycline 100mg PO BID

PO step-down options:  amoxicillin+doxycycline, amoxicillin/clavulanate

Duration:  5 to 7 days.  Consider short course of 5 days if improvement within 48 hours, clinically stable, and the patient is otherwise a healthy individual.

Clinical Pearls

  • If legionella suspected, send urine for legionella (especially in immunocompromised individuals).
  • Switch to PO regimen as soon as clinically appropriate.
  • Respiratory fluoroquinolones (i.e. moxifloxacin) should be avoided due to side effects and increased risk of developing C. difficile Associated Diarrhea.  Use only if patient has severe allergic reaction to beta-lactams.

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