Broaden/switch abx for pts worse after 2-3 days/not improved after 3-5 days, who met dx criteria,¹⁰ are >65 yo, abx in 30 days, hospitalized in 5 days, comorbidities, immunocompromised, local <i>S. pneumo</i> PCN-resistance ≥10%:

¹⁰ Dx: URI w/ 1) Persistent nonimproving s/sx ≥10 days; or 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>¹¹ If no improvement after 2nd abx course, or if seriously ill, refer to specialist; consider cx.
<br><br>¹² Not recommended: oral cephalosporins as empiric mono-tx [W/M], macrolides, TMP/SMX. [S/M]