Antibiotic De-escalation in Culture Negative Pneumonia

is on cefepime, azithromycin, and vancomycin for community-acquired pneumonia . On day 3, 1500 mg azithromycin has been completed, the patient has improved , and a sputum culture shows normal respiratory flora.

The antibiotics are deescalated to oral amoxicillin-clavulanate.

Is this appropriate?

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Yes

Explanation: It is recommended to obtain cultures in patients diagnosed with CAP who are treated with empiric anti-MRSA and anti-Pseudomonal antibiotics. If cultures do not identify MRSA and/or Pseudomonas and the patient is improved, antibiotics should be de-escalated to standard CAP antibiotics to preserve broad-spectrum antibiotics, lower risk for drug toxicities, and lower the risk for C. difficile infection.

Antibiotic De-escalation in Culture Negative Pneumonia

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