9
Table 1. 2007 IDSA/ATS Criteria for Defining Severe CAP
Validated definition includes either one major criterion or three or more
minor criteria:
Minor Criteria
Respiratory rate ≥30 breaths/min
Pa0
2
/Fi0
2
ratio ≤250
Multilobar infiltrates
Confusion/disorientation
Uremia (blood urea nitrogen level ≥20 mg/dL)
Leukopenia
a
(white blood cell count <4,000 cells/mm
3
)
rombocytopenia (platelet count <100,000 /mm
3
)
Hypothermia (core temperature <36°C)
Hypotension requiring aggressive fluid resuscitation
Major Criteria
Septic shock with need for vasopressors
Respiratory failure requiring mechanical ventilation
a
Due to infection alone (i.e. not chemotherapy induced)
Table 2. Initial Treatment Strategies for Outpatients with
Community-acquired Pneumonia
Standard Regimen
No comorbidities or risk factors for
MRSA or Pseudomonas aeruginosa
a
Amoxicillin or doxycycline or macrolide
(if local pneumococcal resistance is <25%)
b
With comorbidities
c
Combination therapy with amoxicillin/
clavulanate or cephalosporin
AND macrolide or doxycycline
d
OR
monotherapy with respiratory fluoroquinolone
e
a
Risk factors include prior respiratory isolation of MRSA or P. aeruginosa or recent hospitalization
AND receipt of parenteral antibiotics (in the last 90 d).
b
Amoxicillin 1 g three times daily, doxycycline 100 mg twice daily, azithromycin 500 mg on first day
then 250 mg daily, clarithromycin 500 mg twice daily, or clarithromycin ER 1,000 mg daily.
c
Comorbidities include chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism;
malignancy; or asplenia.
d
Amoxicillin/clavulanate 500 mg/125 mg three times daily, amoxicillin/clavulanate 875 mg/125
mg twice daily, 2,000 mg/125 mg twice daily, cefpodoxime 200 mg twice daily, or cefuroxime 500
mg twice daily; AND azithromycin 500 mg on first day then 250 mg daily, clarithromycin 500 mg
twice daily, clarithromycin ER 1,000 mg daily, or doxycycline 100 mg twice daily.
e
Levofloxacin 750 mg daily, moxifloxacin 400 mg daily, or gemifloxacin 320 mg daily.
