antibiotics in PNA

[storyhill2]

Need some confirmation or education on this. I think I know why but I have never read it or had it verbalized to me. When we have patients who are admitted to our hospital with CAP most patients are put on ceftriaxone/azithromycin. When there is a more severe pneumonia case or higher likelihood of MDR we will include cover pseudomonas and sometimes mrsa with cefepime/vanc or zosyn/vanc. So my question is when we “go broader” we lose the atypical coverage. I think this is because more severe cases are usually not attributed to atypical pathogens. Is my thinking correct?

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[njac]

Need some confirmation or education on this. I think I know why but I have never read it or had it verbalized to me. When we have patients who are admitted to our hospital with CAP most patients are put on ceftriaxone/azithromycin. When there is a more severe pneumonia case or higher likelihood of MDR we will include cover pseudomonas and sometimes mrsa with cefepime/vanc or zosyn/vanc. So my question is when we “go broader” we lose the atypical coverage. I think this is because more severe cases are usually not attributed to atypical pathogens. Is my thinking correct?

You’re correct - it’s rare that it’s one of our usual atypical causing critical illness. But not to say that it couldn’t be. If we truly think they’re septic from CAP we keep the azithro or doxy on to the broader anti-pseudomonal sepsis regimen. Make sure to get legionella antigen etc (and our RBVP includes a bunch of other atypical) so we can peel it off in a day or two when that’s been ruled out.

 

[yovee]

Sorry but I am very rusty on this. In retail for too long. So the ceftriaxone is to cover the strep pneumo correct? Do you worry about the other gram negatives also (m cat and H flu) or they are just minor bugs (and in which case aren't a first or second gen good enough?). I was always wondering why we use a third gen ceph. Thanks