CAP

Question 1

What is community acquired pneumonia?

Answer 1

CAP = pneumonia occurring in individuals who are not in hospital or have be in hospital for less than 48 hours.

Question 2

What are the common pathogens causing CAP?

Answer 2

• Streptococcus pneumoniae (responsible for severe illness/death esp. in elderly)
• mycoplasma pneumoniae
• chlamydia pneumoniae
• legionella spp.
• H. Influenza (<5% - predominately in patients with COPD)

Question 3

What is pneumonia?

Answer 3

Pneumonia is a type of lung infection, caused by a virus or bacteria. If a person has pneumonia, the alveoli in one or both lungs fill with pus and fluids (exudate), which hinders the gas exchange. This is sometimes known as ‘consolidation and collapse of the lung’.

Question 4

What is the treatment of mild CAP?

Answer 4

Outpatient treatment:

amoxycillin oral
OR if atypical organisms suspected:
doxycycline oral or clarithromycin oral

Tx 3-7 days.

Question 5

What is the treatment of moderate CAP?

Answer 5

benzylpenicillin IV ( narrow soa, gram +, inactivated by beta lactamases)
PLUS
doxycycline oral or clarithromycin oral

If gram negative bacilli identified, add gentamicin to the above regimen
OR
replace benzylpenicillin with ceftriaxone/cefotaxime (3rd gen, broad soa, cover most gran- but not p. aeruginosa)

Question 6

What is the treatment of severe CAP?

Answer 6

Azithromycin IV
PLUS (in all cases)

Ceftriaxone IV 
OR
Benzylpenicillin IV PLUS gentamicin IV 
OR 
Cefotaxime IV