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Community Acquired Pneumonia Treatment

Mike Weinstock, MD and Bryan Hayes, PharmD
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Bryan Hayes and Mike Weinstock review current guidelines for outpatient CAP therapy.

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Phil -

Would given an IM dose of say Ceftriaxone (1g) and oral Azithromycin be as effective and easier on the pt, as two oral medications? Could we possible have the pt follow up the next day to get a second Ceftriaxone injection for a total of 2g, and to re-evaluate how they are doing, and continue oral Azithromycin regimen? I know you mentioned no benefit with IV dosing but would IM dose with a Beta lactam + macrolide be as effective?

Thanks

Phil

Mike W., MD -

Interesting question. Typically ceftriaxone is given in the hospital for CAP but even if the patient returned, there would still only be 2 days of therapy. I would recommend using oral amox/clav (Augmentin) or a 3rd gen oral cephalosporin along with a macrolide (azith) for 7-10 days. No point in the pain of injection, the extra expense, and the hassle or returning. Thx for the thought!

Morris G., 5082187 -

Do you have the references for the section on not using a one-time parenteral antibiotic? I've looked for them but been unsuccessful. The culture of providers in my urgent care is to give them fairly routinely. I'd like to provide literature to back up my stance that they are dangerous without added benefit.

Thanks!

Mike W., MD -

Sure, here you go:
• Belforti, RK et al. Association between initial route of fluoro¬quinolone administration and outcomes in patients hospitalized for community-acquired pneumonia. Clin Infect Dis. 2016 Jul 1;63(1):1-9.
• Haran JP, et al. Factors influencing the development of antibiotic associated diarrhea in ED patients discharged home: risk of administering IV antibiotics. Am J Emerg Med 2014;32:1195-1199

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Franks and Beans Full episode audio for MD edition 191:27 min - 90 MB - M4AHippo Urgent Care RAP - July 2017 Written Summary 279 KB - PDF

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