Probiotics
Immunization incomplete (<2 doses of PCV and HIB)
Patient appropriate for medical unit?
Off pathway, consider chest ultrasound, consulting surgery / ICU / pulmonary / infectious disease
3rd generation oral cephalosporin x10 days
Meets discharge criteria?
X-ray results
> 3 months old?
Failed outpatient therapy?
Empyema, lung abscess or pleural effusion?
Concern for influenza?
Consider pulmonary or ENT consults
URI symptoms?
Contraindications to probiotics?
Respiratory isolation, consider risk factors for MSSA/MRSA infection
Repeat 2 view CXR, consider further diagnostic testing including chest ultrasound, consider infectious disease and pulmonary consults
Concern for foreign body?
> 4 years old?
Risk for atypical pneumonia?
Penicillin allergy?
Consider other source
Empyema, lung abscess or pleural effusion?
Criteria supporting ICU level care
Off pathway, consider chest ultrasound, consulting surgery / ICU / pulmonary / infectious disease
Clinical severity assessment
Meets discharge criteria OR failed outpatient therapy?
Risk for atypical pnemonia?
Patient improving at 48-72 hours?
Signs of dehydration?
Immunization incomplete (<2 doses of PCV and HIB)
Add Azithromycin, consider mycoplasma, chlamydophila and pertussis testing if diagnosis unclear (rarely necessary)
Intensive Care Unit
Medical Unit
Risk for atypical pneumonia
Sputum Gram stain and culture if able to produce (no induced sputum)
Discharge criteria
Chest Physiotherapy (CPT)
Acute phase reactants
Treatment course
Meets ICU criteria?
Consider pediatric or pulmonary consult
Conclusive findings for CAP?
Repeat Chest X-ray
Signs of treatment failure
Factors increasing clinical concern for pneumonia
Penicillin allergy?
Consider other etiology
Add Azithromycin 10 mg/kg PO Qday on day one, 5 mg/kg PO Q day for days 2-5, consider mycoplasma, chlamydophila and pertussis testing if diagnosis unclear (rarely necessary)
May consider acute and convalescent serology for Mycoplasma, Pertussis and Chlamydia. May consider Oseltamivir (if concern for influenza).
Consider for ICU admission
Treat appropriately
Outpatient treatment failure
May NOT need to change antibiotic class if switching to IV (eg. Amoxicillin -> Ampicillin).
Early mobilization