Pneumonia 4. Treatment of community-acquired pneumoniaOne of the decisions the physician must make early on is whether or not to admit the patient to hospital. A scoring system was developed by Fine et al to predict the likelihood of death – based on age, comorbidities, clinical and laboratory features. For patients with a low likelihood of death (e.g. younger patients with few comorbidities who are not very “sick”), pneumonia can be treated as an outpatient. Antibiotics are chosen to address the pneumococcus and the “atypicals” primarily, e.g. a macrolide, a quinolone or doxycycline. Quinolones tend to be preferred for elderly patients, who have a higher risk of a gram-negative enteric infection (against which a macrolide would not be effective).For patients sick enough to require hospitalization, recommended treatments are either the combination of a beta-lactam and a macrolide, or a fluoroquinolone alone.
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