Pneumonia: CAP vs HAP/VAP — Egyptian Empiric Guide (Light Mode)

Pneumonia: CAP vs HAP/VAP

Comprehensive empiric therapy summary — Egyptian clinical context

CAP — Community-Acquired Pneumonia

Setting	Likely Pathogens	Empiric Therapy	Duration
Outpatient (no comorbidities)	S. pneumoniae, H. influenzae, atypicals	Amoxicillin 1 g PO TDS or Doxycycline 100 mg BD or Azithromycin 500 mg day 1 → 250 mg OD × 4 days	5–7 days
Outpatient (with comorbidities)	+ Klebsiella, S. aureus	Amox–Clav 1 g PO BD ± Azithro/Doxy or Levofloxacin 500–750 mg PO OD	7 days
Inpatient (non-ICU)	S. pneumoniae, H. influenzae, Legionella	Ceftriaxone 2 g IV OD + Azithro 500 mg IV/PO OD or Levofloxacin 750 mg IV/PO OD	7 days
ICU / severe	S. pneumoniae, Legionella, S. aureus	Ceftriaxone/Cefotaxime + Azithro or Levofloxacin ± Vancomycin/Linezolid (if MRSA) ± Pip-Tazo (if Pseudomonas risk)	7–10 days

HAP — Hospital-Acquired Pneumonia

Type	Likely Pathogens	Empiric Therapy	Duration
HAP (early-onset)	S. pneumoniae, H. influenzae	Ceftriaxone 2 g IV OD or Ampicillin–sulbactam 3 g IV q6h	7 days
HAP (late/MDR risk)	Pseudomonas, Acinetobacter, MRSA	Pip–Tazo 4.5 g IV q6h or Cefepime 2 g IV q8h or Meropenem 1 g IV q8h ± Vancomycin/Linezolid ± Amikacin/Levofloxacin	7–10 days

VAP — Ventilator-Associated Pneumonia

Setting	Likely Pathogens	Empiric Therapy	Duration
Ventilated ICU patients	Pseudomonas, Acinetobacter, MRSA	Same as late HAP (broad-spectrum triple coverage then de-escalate)	7–10 days

Risk Factors — MRSA & Pseudomonas

MRSA Risk

Prior MRSA colonization or infection
Hospitalization >5 days
IV antibiotic exposure within 90 days
Severe ICU illness

Pseudomonas Risk

Structural lung disease (COPD, bronchiectasis)
Prolonged ventilation
Recent broad-spectrum antibiotic use
High MDR prevalence environment

Clinical Notes & De-escalation

Obtain cultures before starting antibiotics when possible.
Reassess after 48–72h for de-escalation based on cultures and clinical response.
Typical duration: 7 days (extend to 10–14 for complications or slow response).
Switch to oral therapy when stable and afebrile ≥48h.