Clinical evaluation

A. Outpatient treatment of community-acquired pneumonia is largely empirical. All patients should have a chest film taken, since a diagnosis of pneumonia cannot be established in the absence of infiltrates. Patients who have physical findings consistent with pneumonia but negative findings on chest films should be treated as though they have pneumonia.

B. Vital signs should be evaluated and a complete blood cell count should be taken, since certain abnormal values are independent predictors of increased mortality. Sputum and blood culture and sputum Gram's stain should usually be reserved for patients who are sick enough to need hospitalization.

Oral Antibiotic Regimens for Community-acquired Pneumonia

Drug

Recommended regimen

Erythromycin

500 mg q6h

Clarithromycin (Biaxin)

500 mg q12h

Azithromycin (Zithromax)

Day 1,500 mg; then 250 mg qd

Levofloxacin (Levaquin)

500 mg qd

Sparfloxacin (Zagam)

Day 1,400 mg; then 200 mg qd

Trovafloxacin (Trovan)

200 mg qd

Grepafloxacin (Raxar)

600 mg qd

Doxycycline

100 mg bid

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