Adequate empiric antibiotic therapy improves outcome in patients with pneumonia11-13. Conversely, inadequate empiric therapy worsens outcome compared to adequate therapy. Clinicians should therefore seek to deliver adequate empiric antibiotics at the time of clinical diagnosis of pneumonia and not wait until definitive cultures are obtained14. This type of antibiotic approach which starts broad and then reduces therapy based upon objective culture data is termed "de-escalation" therapy. De-escalation has led to reduced antibiotic duration, less antibiotic administered, fewer occurrences of second pneumonias, and less mortality15. The goal of pneumonia therapy is to start adequately and to narrow objectively and as soon as appropriate.