← Master Index· Section 8 · Infectious Diseases · Chapter 44

Respiratory Tract Infections, Lower

CAP · HAP · VAPAcute & chronic bronchitisCURB-65 & empiric antibioticsDiPiro Ch 44 + Pharm Prac V 741

30-Second Snapshot

What it is:A family of lower airway infections that share a location (below the vocal cords) but almost nothing else: acute bronchitis, an acute exacerbation of chronic bronchitis (AECB), bronchiolitis in infants, and pneumonia (CAP, HAP, VAP, and aspiration). Lumped into one chapter because they're all "cough plus something happening in the lung," but they're treated completely differently.

The core problem:Two questions decide everything. First, is this even bacterial, because most acute bronchitis is viral and antibiotics do nothing but cause harm. Second, if it is bacterial pneumonia, where and how did the patient get it, because the answer to that question tells you which organisms you're up against and whether they're likely to be drug-resistant.

What you do about it:Withhold antibiotics from healthy adults with acute bronchitis. Score pneumonia severity with something objective (CURB-65 or PSI), pick empiric coverage based on setting and resistance risk factors, then narrow the regimen once culture data comes back.

Worth knowing

The organizing idea for this whole chapter is the 48-hour clock. Pneumonia onset before 48 hours of hospitalization is CAP. After 48 hours, it's HAP. After 48 hours of endotracheal intubation, it's VAP. That single timestamp is doing enormous work, because it's a proxy for a completely different bug list: CAP is mostly S. pneumoniae, viruses, and atypicals; HAP/VAP is mostly gram-negative rods and S. aureus, and is far more likely to be multidrug-resistant. The clock, not the chest X-ray, is what tells you how wide to swing your empiric antibiotics.

Classify First

Before picking a drug, sort the patient into a bucket. The bucket determines the pathogen list, and the pathogen list determines the regimen.

TypeDefinitionKey risk factors
CAPOnset outside the hospital, or <48 hours after admissionAge >65, diabetes, asplenia, chronic cardiac/pulmonary/renal/liver disease, smoking, alcohol use
HAPOnset >48 hours after hospital admissionWitnessed aspiration, COPD/ARDS/coma, acid suppression (H2RA/PPI), supine positioning, enteral feeding tube, reintubation or tracheostomy, IV antibiotics in prior 90 days (MDR risk)
VAPOnset >48 hours after endotracheal intubationSame as HAP, plus septic shock, ARDS, acute renal replacement therapy, or ≥5 days of hospitalization preceding the pneumonia (all raise MDR risk)
The distinction that gets tested

Aspiration pneumonia isn't its own bug list, it borrows one.Community-acquired aspiration behaves bacteriologically like CAP; hospital-acquired aspiration behaves like HAP. Anaerobes only enter the picture with specific risk factors (periodontal disease, alcoholism, altered consciousness, esophageal disease), and even then they're a supplement to the CAP/HAP regimen, not a replacement for it.

Bronchitis has its own split that's just as important. Acute bronchitisis a short, usually viral illness in an otherwise normal airway. Chronic bronchitisis a chronic diagnosis (productive cough >3 consecutive months/year for 2 consecutive years, once bronchiectasis and TB are excluded), and what actually brings the patient in is an acute exacerbation of chronic bronchitis (AECB)layered on top of that baseline. Treating an AECB like an episode of acute bronchitis, or vice versa, is a common mix-up. Bronchiolitisis neither of these: it's a distinct viral disease of the small airways that essentially only happens in infants and toddlers.

Pathophysiology - Why the Drugs Work

Acute bronchitis: viral injury to big airways

Infection or irritant exposure (pollution, smoke) inflames the epithelium of the trachea and large bronchi. The mucous membranes become hyperemic and edematous, bronchial secretions increase, and the desquamated epithelial cells mix with thickened mucus to impair mucociliary clearance. Influenza A/B, RSV, and parainfluenza are the dominant causes.Bacteria are a minority player, and when they do appear it's usually the same organisms that cause CAP (S. pneumoniae, H. influenzae) or M. pneumoniae. This is why routine antibiotics don't help: you're treating a virus most of the time.

Chronic bronchitis: a chronically compromised airway that periodically decompensates

Years of cigarette smoke, occupational dust and fume exposure, and recurrent infection and inflammation remodel the airway: mucus gland hypertrophy, impaired ciliary function, and a baseline that never fully clears. An AECB happens when that baseline is knocked further off balance, usually by a new viral or bacterial infection. The organisms recovered from sputum during an exacerbation skew toward encapsulated, beta-lactamase-producing gram-negatives and pneumococcus:

Pathogen% of cultures
H. influenzae45% (majority nontypeable; often β-lactamase positive)
M. catarrhalis30% (β-lactamase positive in 95-100%)
S. pneumoniae20% (up to 40% intermediate or resistant to penicillin)
E. coli, Enterobacter, Klebsiella, P. aeruginosa5%

That β-lactamase burden is exactly why plain amoxicillin is a weaker choice here than amoxicillin-clavulanate or a cephalosporin, and why fluoroquinolones earn their place once P. aeruginosabecomes a concern in patients with frequent, severe exacerbations.

Bronchiolitis: the physics of a tiny airway

RSV causes up to 75% of cases (parainfluenza, adenovirus, and influenza make up most of the rest). The virus infects and destroys bronchiolar epithelium, triggering edema, mucus hypersecretion, and sloughed cellular debris that plugs the smallest airways. Poiseuille's law is the whole story here:resistance scales with the fourth power of the radius, so in an airway that's already tiny to begin with, a little mucosal swelling causes a huge jump in airway resistance, which is why previously well infants can decompensate quickly. Nearly 50% of infants are affected in year one of life and essentially 100% by age two.

Pneumonia: three ways in, and why the site of acquisition predicts the bug

Organisms reach the lower respiratory tract by direct inhalation of infectious droplets, aspiration of oropharyngeal contents, or hematogenous spreadfrom an infection elsewhere. In CAP, the most common bacterial cause by far is S. pneumoniae(up to 35% of cases), with H. influenzaeand the atypicals (M. pneumoniae, C. pneumoniae, Legionella) filling out the list; viruses (rhinovirus, influenza) are actually the single most common cause overall, and dominate even more heavily in young children (up to 80% under age 2).

HAP/VAP looks completely different because the exposure is completely different: a hospitalized, often intubated patient is colonized by hospital flora, not community flora. P. aeruginosaand Acinetobacteraccount for roughly 25-45%of HAP, with Klebsiellaand E. colialso common, and S. aureus(frequently MRSA) is a major player. Intubation itself raises pneumonia risk 6- to 21-fold by bypassing the cough reflex and glottic closure that normally protect the lower airway.

The mechanism behind a classic exam fact

Acid-suppressing drugs (H2RAs, PPIs) raise HAP risk. The mechanism: gastric acid is a chemical barrier that normally kills swallowed organisms. Raise the pH and the stomach becomes a reservoir where bacteria proliferate; supine positioning and enteral tubes then make it easy for that colonized gastric content to be aspirated into the lung. It's not a side effect of the drug class acting on the lung, it's the drug removing a defense two organs away.

Clinical Presentation

Acute bronchitis

Starts like a cold, then cough becomes the hallmarkand outlasts everything else, sometimes for 3 weeks or more. Cough is initially dry, then often turns mucopurulent (mucopurulent sputum does notmean bacterial infection, this is a common trap). Fever, when present, rarely exceeds 39°C (102.2°F) and is most typical with adenovirus, influenza, or M. pneumoniae.

The differential that matters

Acute bronchitis should nothave wheezing, shortness of breath, or hypoxemia as prominent features. If those are present, think asthma or bronchiolitis instead, and reconsider the diagnosis.

AECB (acute exacerbation of chronic bronchitis)

Baseline is a productive cough, often worst on waking, with tenacious sputum ranging white to yellow-green. An exacerbation is recognized by the Anthonisen criteria: increased dyspnea, increased sputum volume, and increased sputum purulence. Advanced chronic disease can show cyanosis, digital clubbing, a barrel chest, hyperresonance to percussion, and diminished normal breath sounds with prolonged expiration.

Bronchiolitis (infants)

Preceded by 1-4 days of upper respiratory symptoms (rhinorrhea, congestion, low-grade fever), then progressing to cough, tachypnea (RR 40-80 in hospitalized infants), wheeze and inspiratory rales, retractions, nasal flaring, and grunting. Vomiting and diarrhea plus poor oral intake from coughing frequently produce dehydration. Mild conjunctivitis occurs in about a third of patients and otitis media in 5-10%.

Don't confuse this with bronchitis

Different disease, different age group, different bug profile, different treatment. Bronchiolitis is a viral small-airway disease almost exclusively of infants; bronchitis is a large-airway disease seen at any age. Mixing the names up on an exam or a chart is an easy way to pick the wrong management pathway.

Pneumonia: typical vs atypical presentation

Typical (bacterial)Atypical (M. pneumoniae, C. pneumoniae)
OnsetAbruptGradual
SymptomsFever, chills, productive cough, rust-colored sputum or hemoptysis, pleuritic chest pain, dyspneaMilder, plus prominent extrapulmonary/constitutional complaints (headache, myalgia, malaise)
ExamTachypnea, tachycardia, dullness to percussion, increased tactile fremitus, whispered pectoriloquy, egophony, inspiratory cracklesOften unremarkable relative to symptoms
CXRDense lobar or segmental infiltratePatchy, less dramatic
LabsLeukocytosis with PMN predominance, low oxygen saturationOften unremarkable

This split is why empiric CAP regimens almost always cover bothcategories at once (a beta-lactam for typical pathogens plus a macrolide or doxycycline for atypicals) rather than betting on one presentation being reliably distinguishable from the other in practice.

Diagnosis & Severity Scoring

Bronchitis and bronchiolitis: clinical diagnoses

Acute bronchitis, AECB, and bronchiolitis are all diagnosed by history and exam. Sputum culture in acute bronchitis is essentially uselessbecause expectorated samples can't avoid contamination by normal nasopharyngeal flora, and for the vast majority of patients an etiologic diagnosis wouldn't change the (supportive) treatment anyway. RSV PCR is readily available for bronchiolitis but is not recommended routinely, since a positive or negative result doesn't change management for most infants.

Pneumonia: CXR plus objective severity scoring

Chest radiograph and sputum/blood cultures are the key diagnostic tools for bacterial pneumonia. Blood and noninvasive sputum cultures are recommended for all adults with suspected HAP or VAP(culture data is what lets you de-escalate later). Once pneumonia is suspected, the next step isn't "admit or don't," it's calculating a validated severity score.

CURB-65 criterionThreshold (1 point each)
ConfusionNew disorientation, increased from baseline
UreaBUN >20 mg/dL (7.1 mmol/L)
Respiratory rate≥30 breaths/min
Blood pressureSystolic <90 mm Hg or diastolic ≤60 mm Hg
Age 65≥65 years
What the score actually means

Score <2:outpatient treatment is generally appropriate. Score of 2:admit to a general medical ward. Score ≥3:consider ICU-level care. The Pneumonia Severity Index (PSI)is the tool IDSA guidelines actually prefer, and it's more elaborate (age, comorbidities, exam findings, labs, and imaging all feed into a mortality-risk score), but CURB-65 is the one you can calculate at the bedside in ten seconds, which is why it shows up constantly in practice and on exams.

Treatment Goals & Empiric Selection

Acute bronchitis: treat the patient, not a bacterium

Goal is comfort, plus treating dehydration or respiratory compromise in the rare severe case. Reassurance, fluids, and antipyretics/analgesics are usually sufficient: acetaminophen 650 mg (adults) or ibuprofen 200-800 mg (adults)every 6-8 hours, weight-based in kids. Avoid aspirin in patients under 19because of the Reye syndrome association with viral illness, use acetaminophen instead. Dextromethorphan covers a bothersome mild cough; more severe cough may warrant codeine in adults, but codeine is no longer recommended in pediatric patients. Inhaled beta-agonists and corticosteroids show no meaningful benefit in otherwise healthy patients.

Routine antibiotics: don't

Antibiotic therapy in acute bronchitis is strongly discouraged. The exception is a patient with persistent fever or respiratory symptoms beyond 5-7 days, where a concurrent bacterial infection becomes plausible; then target likely CAP pathogens (S. pneumoniae, H. influenzae), or azithromycin/a respiratory fluoroquinolone if M. pneumoniaeis suspected clinically or confirmed.

Chronic bronchitis and AECB

Stable-disease management overlaps heavily with COPD care: reduce exposure to smoking and occupational irritants, pulmonary rehabilitation, chest physiotherapy and humidification for tenacious secretions, and inhaled bronchodilator therapy (short-acting agents as needed, LABA/LAMA regularly, LABA+ICS combinations for more advanced disease). Long-acting theophylline remains a useful, cheap add-on for severe disease. Roflumilast (a PDE-4 inhibitor) is reserved for moderate-to-severe disease with frequent exacerbations.

For an AECB, antibiotics are decided by the Anthonisen criteria: the more of the three cardinal symptoms present (increased dyspnea, increased sputum volume, increased sputum purulence), the stronger the case for antibiotics. The algorithm then splits by severity:

Using the upper limit of the recommended daily dose for 5-7 daystends to extend symptom-free intervals between exacerbations.

Bronchiolitis

In a well infant, this is self-limiting: reassurance, antipyretics, adequate fluids, done. In severe disease the mainstays are oxygen and IV fluids, not drugs. Aerosolized beta-agonists offer little benefit and may even worsen things; systemic corticosteroids are not recommended. The AAP does support nebulized hypertonic (3%) salinefor hospitalized infants. Ribavirin is not used routinely and is reserved for the most severely ill. For high-risk infants (underlying pulmonary or cardiac disease), RSV prophylaxis during RSV season with palivizumab(a monoclonal antibody) is preferred over RSV immune globulin because of easier administration, no administration-related adverse effects, and no interference with routine immunizations.

Pneumonia: match the regimen to setting and risk

QUESTION 1

How sick are they?

CURB-65 or PSI decides outpatient vs ward vs ICU.

QUESTION 2

Where did they get it?

CAP, HAP, or VAP by the 48-hour clock. This sets the baseline pathogen list.

QUESTION 3

Any resistance risk factors?

Prior MRSA or P. aeruginosa, recent IV antibiotics, structural lung disease, local resistance rates.

SettingRegimen
Outpatient CAP
No comorbiditiesAmoxicillin (preferred), OR doxycycline, OR a macrolide (only where pneumococcal macrolide resistance is <25%)
Comorbidities (diabetes, chronic heart/lung/liver/renal disease, alcoholism, malignancy, asplenia) or immunosuppressionAn antipneumococcal fluoroquinolone (levofloxacin/moxifloxacin) alone, OR a beta-lactam plus a macrolide or doxycycline
Inpatient CAP
NonsevereBeta-lactam + (macrolide or doxycycline). Add antipneumococcal fluoroquinolone if prior respiratory MRSA hx; add vancomycin/linezolid if prior MRSA (obtain cultures, de-escalate at 48h if negative); add antipseudomonal coverage if prior Pseudomonasor recent hospitalization/IV antibiotics (90 days)
SevereBeta-lactam + (macrolide or antipneumococcal fluoroquinolone), with the same MRSA/Pseudomonasadd-ons as above based on risk factors
HAP
Low mortality risk, no MDR factors, local MRSA <20%Piperacillin-tazobactam, cefepime, levofloxacin, imipenem, OR meropenem
Low mortality risk, no MDR factors, local MRSA ≥20% or unknownSame options + ciprofloxacin/aztreonam choice, PLUS vancomycin or linezolid
High mortality risk OR MDR risk factor(s)Double-coverP. aeruginosawith two agents from different classes, PLUS vancomycin or linezolid
VAP
No MDR risk, local resistance both <10%Piperacillin-tazobactam, cefepime, levofloxacin, imipenem, OR meropenem
No MDR risk, local MRSA ≥10%/unknownSame gram-negative options PLUS vancomycin or linezolid
MDR risk factor(s) OR high local resistanceDouble-cover P. aeruginosa(2 different classes) PLUS vancomycin or linezolid
Aspiration pneumonia
Community-acquiredTreat as CAP above
Hospital-acquiredTreat as HAP above
Anaerobes suspected (periodontal disease, alcoholism, altered consciousness)Add clindamycin or metronidazole, or use an agent with intrinsic anaerobic coverage
Duration and stopping rules

Minimum CAP duration is 5 days, though 7-10 days is common in practice. Before stopping, the patient should be afebrile for 48-72 hourswith no more than one sign of clinical instability (tachycardia, tachypnea, hypotension, hypoxia, altered mental status). HAP/VAP duration is 7 days; extending past 10 days hasn't shown clear added benefit and just adds resistance pressure and toxicity. De-escalationfrom broad empiric coverage to a narrower, culture-directed regimen is strongly recommended for HAP/VAP once cultures return negative for MRSA or Pseudomonasand the patient is improving.

Dosing Reference

AntibioticUsual adult dose
Penicillins
Ampicillin ± sulbactam2 g IV every 4-6 hours (every 6 hours if ampicillin-sulbactam)
Amoxicillin ± clavulanate875-2000 mg orally twice daily
Piperacillin-tazobactam3.375-4.5 g IV every 6-8 hours
Cephalosporins / monobactam
Ceftriaxone / cefotaxime1-2 g IV daily / 1-2 g IV every 8 hours
Ceftazidime / cefepime1-2 g IV every 8 hours / 1-2 g IV every 6-8 hours
Ceftolozane-tazobactam3 g IV every 8 hours
Ceftazidime-avibactam2.5 g IV every 8 hours
Aztreonam1-2 g IV every 8 hours
Macrolides / azalides
Azithromycin500 mg day 1, then 250 mg days 2-5 (IV or oral)
Clarithromycin0.5-1 g orally once or twice daily
Erythromycin500 mg IV or orally every 6-8 hours
Fluoroquinolones
Moxifloxacin400 mg IV or orally daily
Levofloxacin750 mg IV or orally daily
Ciprofloxacin400 mg IV every 8 hours / 750 mg orally twice daily
Tetracyclines
Doxycycline100 mg IV or orally twice daily
Carbapenems
Imipenem500-1000 mg IV every 6-8 hours
Meropenem500-2000 mg IV every 6-8 hours
Meropenem-vaborbactam2 g/2 g IV every 8 hours
Aminoglycosides
Gentamicin / tobramycin7.5 mg/kg IV daily (each)
Amikacin15-20 mg/kg IV daily
Polymyxins
ColistinIV: 300 mg × 1, then 150 mg daily; nebulized: 150 mg every 8 hours
Polymyxin B2-2.5 mg/kg × 1, then 1.25-1.5 mg/kg every 12 hours
Other / anti-MRSA
Vancomycin15-20 mg/kg IV every 8-12 hours
Linezolid600 mg IV or orally every 12 hours
Clindamycin600 mg IV or orally every 8 hours, or 450 mg orally every 6 hours
Oral options for AECB specifically
Amoxicillin-clavulanate500-875 mg 2-3 times daily
Doxycycline100 mg twice daily
TMP-SMX DS1 tablet twice daily
Levofloxacin / moxifloxacin500-750 mg daily / 400 mg daily

Class-by-Class Detail

Beta-lactams (penicillins, cephalosporins, carbapenems, monobactam)

These are the backbone of nearly every empiric regimen in this chapter because they cover typical CAP pathogens and, at the antipseudomonal end (piperacillin-tazobactam, cefepime, ceftazidime, imipenem, meropenem, aztreonam), the gram-negatives that dominate HAP/VAP.

Renal dosing shortcuts worth memorizing

Ceftriaxone is the only cephalosporin that does not need renal dose adjustment(hepatobiliary elimination). Nafcillin and oxacillin also don't need adjustment. Nearly every other beta-lactam does.

Carbapenem pearl:all carbapenems cover Pseudomonasexcept ertapenem, which is why ertapenem is not on the HAP/VAP lists above despite being a carbapenem.

Macrolides and doxycycline (atypical coverage)

These cover the "other half" of CAP: M. pneumoniae, C. pneumoniae, and Legionella. That's why a beta-lactam is so often paired with one of these rather than used alone, and why doxycycline or a macrolide can stand on their own in a healthy outpatient with a low pretest probability of resistant pneumococcus.

Macrolide interactions and safety

Never pair clarithromycin or erythromycin with simvastatin or lovastatin(CYP3A4 inhibition raises statin levels and rhabdomyolysis risk). Both also prolong QTc and carry hepatotoxicity risk. Empiric macrolide monotherapy for CAP is only appropriate where local pneumococcal macrolide resistance is <25%,otherwise it's an unreliable single agent.

Renal note:azithromycin and erythromycin need no renal adjustment. Clarithromycin is the odd one out among macrolides and doesrequire adjustment in renal impairment.

Fluoroquinolones

Levofloxacin and moxifloxacin cover typical andatypical CAP pathogens well enough to be used as single agents, which is convenient but also means they get overused. Ciprofloxacin lacks reliable pneumococcal activity and isn't a CAP drug, its role here is gram-negative/Pseudomonascoverage in HAP/VAP.

Black-box and safety issues

Tendon rupture and peripheral neuropathy (can be irreversible), QT prolongation (worst with moxifloxacin), aortic aneurysm/dissection risk (avoid in patients with known aneurysm or major risk factors: PAD, hypertension, Marfan or Ehlers-Danlos syndrome, elderly), dysglycemia (hypo- or hyperglycemia, occasionally severe), and psychiatric adverse effects that can occur after a single dose. Photosensitivity too. Separate dosing from antacids, and calcium/iron/zinc products by 1-2 hours before or 4 hours after, since divalent/trivalent cations chelate the drug and tank absorption.

Renal shortcut:moxifloxacin is the only fluoroquinolone that does notrequire renal dose adjustment (hepatic elimination), which also means it's a poor choice for a lower urinary tract infection since little reaches the urine unchanged, but it's perfectly fine for pneumonia.

MRSA and Pseudomonascoverage in HAP/VAP

Vancomycin and linezolidare the two options for suspected or confirmed MRSA pneumonia. Vancomycin needs trough or AUC-guided monitoring and renal dose adjustment; linezolid doesn't need renal adjustment but carries its own baggage (thrombocytopenia with courses beyond 2 weeks, serotonin syndrome risk with serotonergic drugs, peripheral/optic neuropathy with prolonged use).

A classic pearl

Daptomycin is inactivated by pulmonary surfactant and should never be used for pneumonia, MRSA or otherwise, even though it's a perfectly good MRSA drug everywhere else in the body. This trips people up because daptomycin otherwise looks like a natural vancomycin alternative.

Double-covering Pseudomonasin high-risk HAP/VAP means picking two agents that are active against it from two different classes(for example, an antipseudomonal beta-lactam plus an aminoglycoside or fluoroquinolone), specifically to raise the odds that at least one agent is active while susceptibility data is pending. Delafloxacinis worth knowing as the one fluoroquinolone with activity against both MRSA and Pseudomonasin a single molecule, though it's more often discussed for skin infections than pneumonia specifically.

Special Populations

Pediatric CAP by age

AgeUsual pathogensEmpiric therapy
<1 monthGroup B strep, H. influenzae, E. coli, S. aureus, Listeria, CMV/RSV/adenovirusAmpicillin-sulbactam, a cephalosporin, or a carbapenem (note: cephalosporins don't cover Listeria)
1-3 monthsAtypicals (C. pneumoniae, Ureaplasma), CMV, Pneumocystis; also S. pneumoniae, S. aureusMacrolide/azalide or TMP-SMX; semisynthetic penicillin or cephalosporin for the bacterial possibilities
Preschool, viral pictureRhinovirus, RSV, influenza, parainfluenza, adenovirusAntimicrobials not routinely required
Preschool/school-age, mild-moderate bacterial CAPS. pneumoniae, M. pneumoniae, other atypicalsAmoxicillin or cephalosporin; macrolide/azalide (or fluoroquinolone in school-age) for atypicals
Inpatient, fully immunizedS. pneumoniae, CA-MRSA, atypicalsAmpicillin, penicillin G, or a cephalosporin; add vancomycin/clindamycin for MRSA; add a macrolide/fluoroquinolone/doxycycline for atypical coverage
Worth knowing

Fluoroquinolones are traditionally avoided in children because of concern for cartilage damage in animal models, but they've been used safely for MDR infections in infants and children when the benefit clearly outweighs the theoretical risk. Tetracyclines are avoided under age 8 for permanent tooth discoloration.

High-risk infants and RSV prophylaxis

Infants with underlying pulmonary or cardiovascular disease benefit from RSV prophylaxis during RSV season. Palivizumab(monoclonal antibody, monthly IM dosing) is preferred over RSV immune globulin for ease of administration, lack of infusion-related adverse effects, and because it doesn't interfere with the infant's other scheduled immunizations.

Aspiration risk factors

Periodontal disease, alcoholism, and altered consciousness (sedation, seizure, stroke, intubation) are the classic setups for aspiration. The organism list still follows the CAP/HAP split by setting, anaerobic coverage (clindamycin or metronidazole) is an additionfor suspected anaerobic involvement, not the primary regimen.

Monitoring

ParameterWhenWatching for
Fever curve / vitalsDaily until improvingAfebrile 48-72h + ≤1 sign of instability before stopping antibiotics in CAP
Clinical response, CAPFirst 48-72 hoursProgress expected by day 2, full resolution by day 5-7; if worsening, reassess for wrong bug, wrong drug, empyema, or a noninfectious mimic
Clinical response, HAP/VAP48-72 hours after starting therapyLack of improvement should trigger re-assessment and possible broadening; culture-negative and improving at 48-72h supports de-escalation
Vancomycin trough/AUCBefore 3rd-5th dose (steady state)Sub-therapeutic exposure vs nephrotoxicity
Renal function (SCr, CrCl)Baseline and periodically on renally-cleared agentsNeed for dose adjustment (most beta-lactams, vancomycin, aminoglycosides, fluoroquinolones except moxifloxacin)
QTcBaseline if on other QT-prolonging drugsMacrolides and fluoroquinolones (moxifloxacin especially) add risk
CBC / WBC trendDaily while inpatientResolving leukocytosis; new cytopenia with prolonged linezolid
Oxygen saturation, work of breathingContinuous in hospitalized bronchiolitis or severe pneumoniaNeed for supplemental O2, escalation of respiratory support
AECB symptom-free interval / FEV1Follow-up visitsWhether the exacerbation frequency or severity is worsening over time

Patient Counseling

  • Finish the whole course,even once you feel better in a couple of days. Stopping early is how resistant bugs get selected for.
  • "Your cough can hang around for up to three weeks even after everything else feels better."That's expected with acute bronchitis and doesn't mean treatment failed.
  • For kids and teenagers with a viral illness:"use acetaminophen or ibuprofen for fever, not aspirin, there's a rare but serious brain and liver condition called Reye syndrome linked to aspirin in kids with viral infections."
  • On a macrolide:"tell me if you're on a cholesterol medication, simvastatin and lovastatin specifically don't mix well with this antibiotic and we may need to adjust something."
  • On metronidazole:"no alcohol at all during treatment and for three days after you finish, it causes a genuinely miserable reaction, flushing, nausea, a racing heart."
  • On a fluoroquinolone:"use sunscreen, this can make you burn faster, and call me right away for any tendon pain or swelling, especially in the Achilles."
  • On doxycycline or a fluoroquinolone:"take this a couple hours apart from your calcium, iron, or antacid, those block absorption."
  • For a parent of an infant with bronchiolitis:"there's no antibiotic or magic medicine for this, it's viral. Fluids, saline drops, and time are what actually help. Come back immediately if breathing looks like real work: fast breathing, the skin pulling in between the ribs, flaring nostrils, or if they stop drinking."
  • For chronic bronchitis patients:"the single biggest thing you can do to have fewer of these flare-ups is stopping smoking, more than any inhaler we can add."

High-Yield Recall Sheet

  • The 48-hour clock defines CAP vs HAP vs VAP, and that timestamp is really a proxy for which pathogens (and how resistant they're likely to be) you're dealing with.
  • Acute bronchitis is usually viral(influenza A/B, RSV, parainfluenza); routine antibiotics are discouraged unless fever/symptoms persist >5-7 days.
  • Aspirin is avoided under age 19with viral illness because of Reye syndrome; use acetaminophen.
  • Chronic bronchitis= productive cough >3 months/year for 2 consecutive years, minus bronchiectasis and TB.
  • Anthonisen criteriafor AECB: increased dyspnea, increased sputum volume, increased sputum purulence. More criteria present, stronger the case for antibiotics.
  • H. influenzae (45%), M. catarrhalis (30%), S. pneumoniae (20%)are the top AECB isolates, and most H. flu/M. catare β-lactamase producers.
  • Bronchiolitisis an RSV-driven infant disease (up to 75% of cases); no routine bronchodilators, no routine systemic steroids; nebulized 3% saline for hospitalized infants; palivizumab for high-risk prophylaxis.
  • S. pneumoniae causes up to 35%of bacterial CAP; viruses (rhinovirus, influenza) are the single most common overall cause.
  • HAP/VAP is dominated by gram-negatives(P. aeruginosa, Acinetobacter~25-45%) and S. aureus, and is far more likely to be MDR than CAP.
  • Acid-suppressing drugs raise HAP riskby letting bacteria colonize the stomach, which can then be aspirated.
  • CURB-65:confusion, urea >20 mg/dL, RR ≥30, BP <90/60, age ≥65. Score <2 outpatient, 2 admit, ≥3 consider ICU. PSI is the IDSA-preferred alternative.
  • Outpatient CAP, no comorbidities:amoxicillin preferred, doxycycline or macrolide as alternatives (macrolide only if local resistance <25%).
  • CAP minimum duration is 5 days; stop once afebrile 48-72h with ≤1 instability sign. HAP/VAP duration is 7 days.
  • Double-cover Pseudomonaswith two agents from different classes in high-risk HAP/VAP pending cultures, then de-escalate.
  • Daptomycin is never used for pneumonia, pulmonary surfactant inactivates it.
  • Ceftriaxone and moxifloxacinare the renal-adjustment-free standouts in their classes; clarithromycin is the macrolide that unusually doesneed renal adjustment.
  • Never combine a macrolide (clarithro/erythro) with simvastatin or lovastatin.
  • Fluoroquinolonescarry black-box risk for tendon rupture and aortic aneurysm/dissection, plus QT prolongation, dysglycemia, and psychiatric effects.
  • Ertapenem is the one carbapenem without Pseudomonascoverage.
  • Aspiration pneumonia bacteriology mirrors CAP or HAPdepending on where it happened; anaerobic coverage is an add-on, not the base regimen.