For pts meeting dx criteria⁴ who are >65 yo, abx in 30 days, hospitalized in 5 days, comorbidities, immunocompromised, or local <i>S. pneumo</i> PCN-resistance ≥10%:

⁴ Dx: URI w 1) Persistent nonimproving s/sx ≥10 days; 2) Severe sx: Temp ≥39°C and purulent nasal d/c or face pain for 3-4 days at onset; or 3) Worsening s/sx including new fever/HA/nasal d/c increase following typical 5-6 days URI that initially improved (double-sickening). [S/L-M]<br><br>⁵ Broaden coverage/switch to different abx class if pt worsens after 48-72 h or fails to improve after 3-5 days. [S/M]

<br><br>⁶ Not recommended: oral cephalosporins as empiric mono-tx [W/M], macrolides, TMP/SMX. [S/M]