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Critical Care Medicine

Answer 3
  1. Ceftriaxone and erythromycin. The etiologic agents of severe community-acquired pneumonia include Streptococcus pneumoniae, Legionella species, aerobic gram-negative bacilli, Mycoplasma pneumoniae, respiratory viruses, and Haemophilus influenzae. The presence of numerous inflammatory cells in the sputum indicates that the specimen is adequate. The absence of a predominant organism suggests that Legionella or Mycoplasma are likely pathogens. The chest radiograph is atypical for respiratory viruses. Legionella species are particularly likely to cause pneumonia in elderly patients with comorbid disease. According to the guidelines of the American Thoracic Society and the British Thoracic Society, the initial treatment of severe hospitalized community-acquired pneumonia should include a macrolide antibiotic together with a third-generation cephalosporin.7,8

    7. Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy. American Thoracic Society. Medical Section of the American Lung Association. Am Rev Respir Dis 1993;148:1418-1426.

    8. The British Thoracic Society and the Public Health Laboratory Service: Community-acquired pneumonia in adults in British hospitals in 1982-1983: a survey of aetiology, mortality, prognostic factors, and outcome. Q J Med 1987;62:195220.

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