Vaccinations (influenza and Pneumococcal)
Hand and cough hygiene
Reversing gastric acid suppression if applicable
Antibiotics past 90 days (esp. same class)
Travel history outside of Canada
Post-influenza or URTI as a Staph aureus risk factor
Aspiration without infection (no fever or no ↑ WBC)
Non-Influenza Viral infection
COPD exacerbation / Bronchitis
Mycoplasma and other atypicals
Initial Chest X-Ray (Upon Presentation): Consider chest x-ray to support the clinical diagnosis of pneumonia for outpatients
Follow-up Chest X-Ray: Consider a follow-up chest x-ray 6-8 weeks after initial diagnosis of pneumonia for patients who fit into one or more of the following categories: recurrent pneumonia in the last year, smokers, OR age greater than 50 years
1st Line Tests:
Throat swab for Mycoplasma PCR +/- Mycoplasma serology
Viral respiratory screen (Flu and RSV)
Legionella (serogroup 1) urine antigen (travel associated or severe disease)
2nd Line Tests for non-responders or immunocompromised:
Viral respiratory panel (13 Viruses)
Sputum/induced sputum for mycobacterium, cytology, and Pneumocystis
CMV shell vial +/- CMV viral load
Legionella serology (rarely used)
Fungal: Histoplasmosis Blastomyces testing
Before discontinuing therapy, the IDSA CAP guidelines recommends that patients with CAP should be:
Longer durations of therapy are usually not necessary since most patients become clinically stable in 3–7 days.
Criteria for clinical stability:
Antibiotics are listed in the numerical order of preference.
Avoid using the same class of antibiotics if used within the last 90 days.
Tailoring of treatment after susceptibilities are known is highly recommended.
CURB-65 score may have utility to determine if hospitalization is required.
See link to assessment above.
Health PEI Physician Reviewers: Dr. Nicole Drost, Dr. Nicole Fancy, Dr. Greg German, Dr. Ayodeji Harris-Eze, Dr. Heather Morrison, Dr. Huy Nguyen, Dr. Aaron Sibley
Pharmacists: Wendy Cooke (QEH ICU/CCU Clinical Pharmacist), Jennifer Boswell (Antimicrobial Stewardship Pharmacist)