1. Pnuemonia severity index > 71 with risk of mortality >2.8%
2. If comorbidities includ that of neoplastic disease, liver disease, CHF; if altered ental status, tachypnea, hypotension, hypothermia or hyperthermia; if acidotic, elevated BUN, hyponatremia, hyperglycemia.
1. Outpatients <60YO: S pneumonia, mycoplasma, chylamidia, legionella = Macrolides (azithro, erythro, clarithromycin), doxycycline are all first line. Second line try fluoroquinolones (cipro, moxifloxacin). Do not use 3rd generation ceph or penicillins because not good coverage for atypicals.
2. Outpatents >60YO: more likely to have typicals (S pneumo, H influ, Klebsiella) so 2nd or 3rd generation cephalosportin is the first line treatment. Alternatives include that of zosyn (amoxicillin/clavulanic acid, macrolides, and fluoroquinolones (levo and moxifloxacin - these are two with good pneumonoccal coverage too).