Emergency Medicine Board Bombs 269. Pneumonia Tx- Simplified.
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Oct 13, 2025 Explore the nuances of pneumonia treatment, from IV versus PO antibiotics to patient-specific regimens. Discover the standard inpatient care for community-acquired pneumonia and the importance of recognizing treatment failure. Learn when to consider broad-spectrum therapy and MRSA coverage, as well as tailored approaches for aspiration and nursing home patients. Delve into the critical role of steroids for severe cases and why outpatient care can often be managed effectively with oral alternatives.
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Standard Inpatient CAP Regimen
- For admitted community-acquired pneumonia, start IV ceftriaxone plus azithromycin as the standard inpatient regimen.
- Expect most centers to default to IV dosing on admission, then switch to PO when stable.
Aspiration And Nursing Home Overlap
- Non-toxic aspiration pneumonia usually still gets standard CAP coverage rather than anaerobic-heavy regimens.
- The same applies for dialysis or nursing home patients who look well overall.
Handle Penicillin Allergies Deliberately
- If true penicillin allergy exists, substitute ceftriaxone or use respiratory fluoroquinolone monotherapy when necessary.
- Challenge reported penicillin allergies in the ED when appropriate, since most are over-reported.