Sandbox vidit

Characterize the symptoms & signs: Fever Cough with sputum Dyspnea Pleuritic chest pain

Examine the patient: Fever and/or Tachypnea and/or Rales and/or Increased TVF

; Order CBC Perform Sputum gram stain Sputum culture Blood culture

; Order a chest X-ray Evaluate for severity of illness Comorbid factors if any Start oxygenation if needed

; If suspecting atypical pneumonia then obtain Urine legionella antigen Enyzme Immunoassay (EIA) Immunoflorescence PCR Fibre optic bronchoscopy Biopsy for Histopathology

Start empiric therapy for Community acquired pneumonia while awaiting culture results

Outpatients with no recent antibiotic exposure and no comorbidities

Outpatients with recent antibiotic exposure and no comorbidities

Hospitalized patient

Critically ill patients

; Azithromycin 500 mg PO single dose followed by 250 mg PO daily for 4 more days OR Doxycycline 100 mg PO for 5 days

; Respiratory fluoroquinolone ( Moxifloxacin ) OR Macrolide (Azithromycin or clarithromycin) With or Without Amoxicillin 1 g PO for atleast 5 days

; Ceftriaxone 1g IV daily OR Cefotaxime 1g IV q8h PLUS Azithromycin or Clarithromycin OR Respiratory fluoroquinolone ( Moxifloxacin )

; Add Azithromycin or a Respiratory fluoroquinolone ( Moxifloxacin )to B-Lactam for L.pneumophila Add Vancomycin for MRSA coverage Add IV penicillin G to cover S.Pneumoniae Add antipseudomonal B-Lactam to antipseudomonal fluoroquinolone ( Ciprofloxacin / Levofloxacin ) to cover Pseudomonas aeruginosa

; If culture results are available then treat accordingly If no response to treatment or suspicion of any complication then consider

Pleural Effusion

Empyema

Perform thoracocentesis and analyse pH Cell count Gram stain Bacterial culture Protein Lactate dehydrogenase

Drain the empyema