You are called by the emergency department and told of a 72-year-old male nonsmoker with a history of diabetes, coronary artery disease, and hypertension who presents with pneumonia and needs to be admitted to the hospital. The patient is febrile and tachypneic, has a blood pressure of 145/65, and has an oxygen saturation of 95% on room air. Physical examination is significant for rhonchi in the right lower lung fields, and a chest x-ray shows a right lower lobe infiltrate. Laboratory studies show a white blood cell count of 14,000 and no evidence of acute renal failure. Blood cultures have been obtained and an unknown antibiotic has been started in the emergency department.
1. Should this patient be admitted to the hospital?
2. What historical information is needed to make a treatment decision for this patient?
3. What is the best initial treatment if this patient has no antibiotic allergies and no significant contact with the health care system?