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Community-Acquired Pneumonia

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ÎThe first treatment dose for hospitalized patients should be given in the emergency department (ED) as soon as possible after the diagnosis of CAP is made. ÎEmpiric therapy for outpatients (Table 4) should consider: > If previously healthy and no use of antimicrobials within previous 3 months > If presence of comorbidities or use of antimicrobials within the previous 3 months > If from a region with a high rate of infection with macrolide-resistant S. pneumoniae ÎEmpiric therapy for inpatients (Table 4) should consider: > In medical wards: Prior antimicrobials within the past three months? > In ICU: Is Pseudomonas or CA-MRSA infection an issue? β-Lactam allergy? ÎRecommendations are generally for a class of antibiotics rather than for a specific drug, unless outcome data clearly favor one drug. > More potent drugs are given preference because they may decrease the risk of selecting for antibiotic resistance. ÎPatients with CAP should be treated for a minimum of 5 days, should be afebrile for 48-72 hours, and should have no more than one CAP-associated sign of clinical instability before stopping therapy. Longer durations of therapy may be needed if initial therapy was not active against the identified pathogen or if complicated by extrapulmonary infection such as meningitis or endocarditis or associated with bacteremia. ÎPrevention of CAP: Influenza > Inactivated influenza vaccine* for persons age > 50, others at risk for influenza complications, household contacts of high-risk persons, and healthcare workers as recommended by the Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention. > Intranasal live attenuated vaccine* for certain persons age 2-49 years without chronic underlying diseases, including immunodeficiency, asthma, or chronic medical conditions. > Healthcare workers in inpatient, outpatient, or long-term care facilities should receive annual immunization. Pneumococcus > Pneumococcal polysaccharide vaccine* for persons age ≥ 65 years and those with selected high-risk concurrent diseases, according to ACIP guidelines. ÎSmoking cessation should be a goal, particularly for hospitalized patients with CAP. *In the United States, check for interim recommendations about influenza vaccination during the 2009–10 season.

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