Question 13

How do you decide which patients with CAP should be admitted?

Admission decisions should be based on pre-existing conditions that compromise the safety of home healthcare, a PSI of IV or V and clinical judgment. IDSA guidelines published in 2000 indicate that patients in Pneumonia Outcomes Research Team (PORT) class III may require brief hospitalization. However, the updated IDSA guidelines published in 2003 recommend home care for classes I, II, and III (56, 57). Due to levofloxacin’s excellent bioavailability the reasons for admitting people to hospital are much diminished. The excellent oral therapy provided by levofloxacin means that lower risk patients really only need to be admitted because they cannot tolerate oral therapy due to nausea and vomiting, they are hypoxic (O₂saturation < 90) and need to be on oxygen, they are frail, or have comorbidities requiring therapy, or there are unstable living conditions (58).