Pneumonia 35
BUY
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cidal titers, minimum inhibitory concentration, minimum bactericidal
concentration. Repeat C&S in 48h, then once a week. Antibiotic levels peak and
trough at 3rd dose. UA, urine C&S.
Pneumonia
1. Admit to:
2. Diagnosis: Pneumonia
3. Condition:
4. Vital signs: q4-8h. Call physician if BP >160/90, <90/60; P >120, <50; R>25,
<10; T >38.5
C or O
2
saturation <90%.
5. Activity:
6. Nursing: Pulse oximeter, inputs and outputs, nasotracheal suctioning prn,
incentive spirometry.
7. Diet: Regular.
8. IV Fluids: IV D5 1 NS at 125 cc/hr.
9. Special Medications:
-Oxygen by NC at 2-4 L/min, or 24-50% by Ventimask, or 100% by non-
rebreather (reservoir) to maintain O
2
saturation >90%.
Moderately ill Patients Without Underlying Lung Disease from the
Community:
-Cefuroxime (Zinacef) 0.75-1.5 gm IV q8h OR
Ampicillin/sulbactam (Unasyn) 1.5 gm IV q6h AND EITHER
-Erythromycin 500 mg IV/PO q6h OR
Clarithromycin (Biaxin) 500 mg PO bid OR
Azithromycin (Zithromax) 500 mg PO x 1, then 250 mg PO qd x 4 OR
Doxycycline (Vibramycin) 100 mg IV/PO q12h.
Moderately ill Patients With Recent Hospitalization or Debilitated Nursing
Home Patient:
-Ceftazidime (Fortaz) 1-2 gm IV q8h OR
Cefepime (Maxipime) 1-2 gm IV q12h OR
Cefoperazone (Cefobid) 1-2 gm IV q8h AND EITHER
Gentamicin 1.5-2 mg/kg IV, then 1.0-1.5 mg/kg IV q8h or 7 mg/kg in 50 mL
of D5W over 60 min IV q24h OR
Ciprofloxacin (Cipro) 400 mg IV q12h or 500 mg PO q12h OR
Levofloxacin (Levaquin) 500 mg IV/PO qd.
Critically ill Patients:
-Initial treatment should consist of a macrolide with 2 antipseudomonal agents
for synergistic activity:
-Erythromycin 0.5-1.0 gm IV q6h AND EITHER
-Ceftazidime 1-2 gm q8h OR
Piperacillin/tazobactam (Zosyn) 3.75-4.50 gm IV q6h OR
Ticarcillin/clavulanate (Timentin) 3.1 gm IV q6h OR
Imipenem/cilastatin (Primaxin) 0.5-1.0 gm IV q6h AND EITHER
-Levofloxacin (Levaquin) 500 mg IV q24h OR
Ciprofloxacin (Cipro) 400 mg IV q12h OR
