Community Acquired Pneumonia
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Transcript of Community Acquired Pneumonia
COMMUNITY ACQUIRED PNEUMONIA
Pam Charity, MDCathryn Caton , MD, MS
Objectives Define pneumonia
Review criteria for diagnosis
Review criteria for admission
Review treatment options
Pneumonia Fever Leukocytosis Infiltrate on CXR
Diagnosis History
Physical Exam
Laboratory Data
Radiographic findings
Hospital Admission Decision
Severity of Illness Scores – CURB-65 (confusion, uremia, respiratory rate, low blood pressure, age 65 or greater)
Consider other factors – ability to safely and reliably take oral medication, support resources
CURB-65 > or = 2, more intensive treatment
ICU Admission Decision Major criteria
Septic shock requiring vasopressors Acute respiratory failure requiring intubation and
mechanical ventilation Minor Criteria
Respiratory rate >30 PaO2/FiO2 ratio <250 Multilobar infiltrates Confusion BUN >20 Leukopenia, thrombocytopenia Hypothermia
Outpatient Treatment Healthy and no risk factors for drug
resistant S. Pneumoniae
Macrolide – azithromycin
Doxycycline
Outpatient Treatment Patients with
co-morbid conditions – chronic heart, lung, renal disease; DM; ETOH; malignancies; asplenia; immunosuppressing drugs
use of abx within last 3 months or other risk for drug resistant S. Pneumoniae Then use
fluoroquinolone B – Lactam plus macrolide or amoxicillin-
clavulanate
Inpatient, non –ICU Treatment
Fluoroquinolone B-Lactam plus a macrolide
First dose of antibiotics should be administered in the ED after blood cultures are obtained.
Inpatient, ICU Treatment
B-Lactam plus either azithromycin or a fluoroquinolone
For pseudomonas use B-Lactam plus fluoroquinolone or B-Lactam plus an aminoglycoside and
azithromycin or B-Lactam plus an aminoglycoside and a
fluoroquinolone
Switch from IV to Oral
Patients should be switched when Hemodynamically stable Clinically improving Able to tolerate oral medications
Patients should be discharged as soon as clinically stable without other active issues
Duration of Antibiotic Therapy
Minimum of 5 days
Afebrile for 48-72 hours
No more than 1 CAP associated sign of clinical instability
References IDSA / ATS Guidelines Clinical Infectious Diseases 2007; 44:S2
7-72