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CAP (DIAGNOSIS (URINARY ANTIGEN TESTS, PCR, BLOOD CULTURE, SEROLOGY, GRAM…

- - - - Respiartory Fluoroquinolone
        
        Beta lactam PLUS Macrolide OR IV Azithromycin
    - - Beta lactam PLUS Azithromycin OR Fluoroquinolone
    - - 2) Comorbidities or AB in past 3 months/ Regions where high rate of high level pneumococcal macrolide resistance
        
        Respiratory Fluoroquinolone or
        
        Beta lactam + Macrolide
      - 1) Previously healthy and no AB in past 3 months
        
        Macrolide or
        
        Doxycycline
    - - 1) Pseudomonas Anti pseudomonal Beta lactum PLUS Aminoglycoside PLUS Antipneumococcal Fluoroquinolone
      - 2) CA- MRSA
        Add Linezolid or Vancomycin
  - - - Adrenal Insufficiency
      - Nosocomial Super infections
  - - - Major Criteria (1 or more = ICU admit)
        
        Endotracheal intubation and mechanical ventilation
        Shock requiring vasopressors
      - Minor Criteria (3 or more = ICU admit)
        "Highly Disoriented Lunatic TRUMP"
        
        Hypothermia (core temperature < 36oC)
        Hypotension requiring aggressive fluid resuscitation
        Confusion or delirium
        Leukopenia (WBC count < 4000 cells/mm3)
        Thrombocytopenia (platelet count < 100,000 cells/mm3)
        Respiratory rate > or = 30 min-1
        Blood urea nitrogen (BUN) > or = 20 mg/dL
        Multilobar infiltrates
        PaO2-to-FiO2 ratio < or = 250
    - - CONFUSION
        UREA >7MMOL/L
        RESPIRATORY RATE >30/MIN
        BP- 90/60
        AGE> 65YEARS
  - - - PNEUMOCOCCAL VACCINE
        
        PCV-3- PROTEIN CONJUGATE PNEUMOCOCCAL VACCINE CAPSULAR POLYSACCHARIDE FROM 13 OF THE MOST FREQUENT PNEUMOCOCCAL PATHOGENS AFFECTING CHILDREN IS LINKED TO AN IMMUNOGENIC PROTEIN
        
        PPV-3- PNEUMOCOCCAL POLYSACCHARIDE VACCINE
        CONTAINS CAPSULAR MATERIAL FROM 23 PNEUMOCOCCAL SEROTYPES
      - INFLUENZA VACCINE
        
        INTRAMUSCULAR INACTIVATED VACCINE
        
        INTRANASAL LIVE ATTENUATED COLD ADAPTED VACCINE (CI IN IMMUNOCOMPROMISED)
        
        IF INFLUENZA OUTBREAK, UNPROTECTED PATIENTS SHOULD BE VACCINATED IMMEDIATELY, GIVEN CHEMOPROPHYLAXIS- OSELTAMIVIR OR ZANAMIVIR FOR 2 WEEKS- IE UNTIL VACCINE INDUCED AB LEVEL ARE SUFFICIENTLY HIGH
- - - - Bats
      - Birds
      - Rabbits
      - Cattle, parturient cats