CAP — outpatientHealthy vs comorbid (ATS/IDSA 2019) FREEPulmonology

Group	First line	Penicillin allergy / alternative	Duration
Healthy	Amoxicillin 1 g TDS, or doxycycline 100 mg BD (macrolide only if pneumococcal macrolide resistance < 25%)	Doxycycline or macrolide	5 days minimum (stable 48 h)
Comorbid (heart/lung/liver/renal disease, DM, alcohol, cancer, asplenia)	Amoxicillin-clavulanate or cefuroxime/cefpodoxime + macrolide or doxycycline	Respiratory FQ alone (levofloxacin 750 mg or moxifloxacin)	5 days minimum

• Use CURB-65 (0–1) / clinical judgement to decide outpatient care.
• Antibiotics in the last 3 months = choose a different class.

Ciprofloxacin is NOT a respiratory fluoroquinolone — it misses pneumococcus; the CAP quinolones are levofloxacin and moxifloxacin.

CAP — ward (non-ICU)Hospitalised, non-severe FREEPulmonology

First line	Penicillin allergy / alternative	Duration
Beta-lactam (ceftriaxone 1–2 g daily, cefotaxime or ampicillin-sulbactam) + macrolide (azithromycin)	Respiratory FQ alone (levofloxacin/moxifloxacin)	5 days minimum; 7 days if MRSA/Pseudomonas

• Beta-lactam + doxycycline if macrolide and FQ both contraindicated.
• Add MRSA (vancomycin/linezolid) or Pseudomonas (pip-tazo, cefepime, meropenem) cover empirically only with prior respiratory isolation of that organism; after recent hospitalisation + IV antibiotics (90 days), send cultures and add cover only if they grow the organism.
• First dose in the emergency department; switch to oral when clinically stable.

The macrolide is there to cover atypicals (Legionella) — ceftriaxone alone is the classic wrong answer in a patient with diarrhoea, confusion and low sodium.

CAP — severe / ICUCURB-65 ≥ 3 or IDSA severe criteria FREEPulmonology

First line	Penicillin allergy / alternative	Duration
Beta-lactam (ceftriaxone, cefotaxime or ampicillin-sulbactam) + azithromycin, or beta-lactam + respiratory FQ	Respiratory FQ + aztreonam	5–7 days; 7 days if MRSA/Pseudomonas

• Severe CAP always gets combination therapy — not FQ monotherapy.
• MRSA cover (vancomycin or linezolid) if post-influenza necrotising/cavitating pneumonia or prior MRSA; Pseudomonas cover if prior respiratory isolation or recent hospitalisation + IV antibiotics (90 days).
• Antibiotics within 1 hour; hydrocortisone is now suggested for severe CAP (recent SCCM/ATS guidance).

Post-influenza cavitating pneumonia with Gram-positive cocci in clusters = add vancomycin or linezolid to ceftriaxone (MRSA).

HAP / VAP≥ 48 h after admission or intubation (IDSA/ATS 2016) Pulmonology

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Aspiration pneumonia & lung abscessWhen to cover anaerobes Pulmonology

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Atypical pneumoniaLegionella, Mycoplasma, Chlamydophila Pulmonology

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Uncomplicated cystitisNon-pregnant woman (IDSA) Infectious Diseases

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UTI in pregnancy & asymptomatic bacteriuriaWho to treat and with what Infectious Diseases

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Acute pyelonephritisOutpatient vs inpatient Infectious Diseases

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Bacterial prostatitisAcute and chronic Infectious Diseases

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Cellulitis & erysipelasNon-purulent (IDSA 2014) Dermatology

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MRSA skin & soft tissueAbscess / purulent infection Dermatology

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Necrotising fasciitisSurgical emergency Emergency & Toxicology

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Diabetic foot infectionIDSA/IWGDF 2023 Endocrinology & Diabetes

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OsteomyelitisHaematogenous & vertebral Rheumatology & Immunology

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Bacterial meningitis — empiricalBy age and risk (IDSA) Neurology

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Bacterial meningitis — by organismDirected therapy and duration Neurology

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Meningococcal contact prophylaxisClose contacts Infectious Diseases

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Brain abscessEmpirical therapy Neurology

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Infective endocarditis — empiricalBefore cultures return Cardiology

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Infective endocarditis — by organismDirected therapy (AHA/ESC) Cardiology

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Endocarditis prophylaxisDental procedures (AHA 2021 / ESC) Cardiology

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Spontaneous bacterial peritonitisTreatment and prophylaxis (AASLD) Gastroenterology & Hepatology

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Acute cholangitisTokyo 2018 Gastroenterology & Hepatology

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Complicated intra-abdominal infectionPeritonitis, abscess, diverticulitis Gastroenterology & Hepatology

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Clostridioides difficileIDSA/SHEA 2021 Gastroenterology & Hepatology

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H. pylori eradicationACG 2024 / Maastricht VI Gastroenterology & Hepatology

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Infectious diarrhoeaWhich organism needs what Infectious Diseases

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BrucellosisCommon in the Gulf (raw milk, livestock) Infectious Diseases

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GonorrhoeaCDC 2021 Infectious Diseases

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SyphilisBy stage (CDC 2021) Infectious Diseases

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Pelvic inflammatory diseaseCDC 2021 Infectious Diseases

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Active TBDrug-sensitive (WHO/ATS) Pulmonology

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Latent TB infectionPreventive therapy (CDC) Pulmonology

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Pneumocystis (PCP / PJP)Treatment and prophylaxis Infectious Diseases

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MalariaFalciparum (WHO) and vivax/ovale Infectious Diseases

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Lyme diseaseIDSA 2020 Infectious Diseases

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Febrile neutropeniaTemp ≥ 38.3 or ≥ 38.0 for 1 h + ANC < 500 Hematology & Oncology

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Sepsis — unknown sourceSurviving Sepsis 2021 Emergency & Toxicology

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Asplenia / splenectomyVaccines and prophylaxis Hematology & Oncology

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Pseudomonas coverageWhich drugs do and do not cover Infectious Diseases

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ESBL & carbapenem-resistant Gram-negativesIDSA AMR guidance 2024 Infectious Diseases

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VREVancomycin-resistant enterococci Infectious Diseases

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