Community Acquired Pneumonia

Question 1

What is pneumonia?

Answer 1

Inflammation of the alveoli, usually due to infection.

Question 2

Who is most at risk of CAP?

Answer 2

*elderly
*infants
*immunocompromised

Question 3

What are symptoms of CAP?

Answer 3

Can be abrupt or gradual if patient has pre existing respiratory infection
*cough
*fever
*pleural pain (rib pain)
*dyspnoea- shortness of breath
*consolidation shown on chest x-ray

Question 4

How is pneumonia diagnosed?

Answer 4

*isolation of bacteria from sputum or blood
*detection of antigen in sputum or blood

Question 5

What are important risk factors for CAP?

Answer 5

*diabetes mellitus
*coronary heart failure
*ischaemic heart disease
*COPD

Question 6

What pathogen most commonly causes CAP?

Answer 6

Streptococcus pneumoniae

Question 7

What is the CURB-65 severity score?

Answer 7

Clinical prediction tool for mortality in CAP. Score 1 point for each present.
*C- confusion
*U-urea: raised blood urea nitrogen >7mmol/L
*R- respiratory rate: >30 breaths/min
*B- blood pressure: low. Systolic<90mmHg OR diastolic <60mmHg
*65- 65 years plus
NB- 0-1=low, 2= moderate 3-5=high risk death (hospital admission needed)

Question 8

When is CRB-65 used?

Answer 8

Community- blood urea doesn’t need tested. So CAP can be diagnosed in primary care.
1-2= consider hospital assessment
3-4= urgent hospital assessment needed

Question 9

What is the treatment for CAP?

Answer 9

*analgesia- pleuritic pain- paracetamol
*fluids
*oxygen- treat hypoxia
*nutrition
*antibiotics- within 4 hours diagnosis. 1 hour if suspected sepsis

Question 10

What is the treatment for CRB65 score 0-1?

Answer 10

Amoxicillin 500mg capsules- take one three times daily for 5 days =15 caps
(Pen allergy- doxycycline 200mg capsules stat then 100mg once a day for 4 days= 5 days= 6 caps)

Question 11

What is the treatment for CAP CRB65 score 2?

Answer 11

Amoxicillin 500mg capsules- one to two capsules three times daily for 5 days
Pregnant- erythromycin 500mb tablets- one four times daily for 4 days = 20 tabs
Pen allergy- doxycycline 200mg cap stat then 100mg daily for 4 days= 5 days

Question 12

What is the treatment for children with CAP over 1 month old (non severe symptoms)

Answer 12

Amoxicillin oral suspension
1m-11m = 125mg three times daily
1-4 years= 250mg three times daily
5-17 years= 500mg three times daily for 5 days

Pen allergy- clarithromycin oral suspension- based on weight

Question 13

What is the treatment for CAP CRB65 3-4?

Answer 13

Co-amoxiclav- 500 mg three times daily oral for 5 days or 1.2g three times daily IV
WITH
Clarithromycin 500 mg twice daily oral or IV for 5 days
Pen allergy- Levofloxacin 500mg twice daily oral or IV 5 days

Question 14

When should IV antibiotic treatment be reviewed for change to oral?

Answer 14

Before 48 hours

Question 15

What advice should be given to patients?

Answer 15

*possible adverse effects of antibiotics
*how long symptoms most likely to last
*seek help if symptoms worsen, don’t improve after 3 days or become systemically very unwell