Using the case of a 66-year-old man with underlying chronic obstructive pulmonary disease (COPD) who presented to the emergency department with symptoms consistent with community-acquired pneumonia, the authors of a Clinical Practice vignette discuss diagnosis, empiric treatment, microbiologic testing, and choice of antimicrobial agent for this patient.
Th patient “should be admitted to a general ward,” the authors write. “Although a viral pathogen was identified, we would be concerned about secondary bacterial infection, particularly given the elevated procalcitonin level. In the absence of known risk factors for MRSA or pseudomonas, we would initiate treatment in the emergency department with intravenous azithromycin and ceftriaxone. If testing proved negative for atypical bacteria, we would discontinue azithromycin therapy. We would discharge him with continued oral therapy (e.g., amoxicillin–clavulanate if no bacterial pathogen was identified); if his condition had reached clinical stability in 48 to 72 hours, he should complete a 5-day course of the medication. Outpatient follow-up should be scheduled a week after discharge.”