Pneumonia Flashcards
Pneumonia: Pathophysiology
Pneumonia develops when an organism invades the lung parenchyma and the host defenses are depressed
Bacterial pneumonia results when the lung’s primary defense mechanisms are altered by a viral infection or immunological problems
Chronically ill patients of all ages are more prone to pneumonia
Pneumonia: Common Adult Pathogens
Streptococcus pneumoniae
Patients with underlying lung disease
- Nontypable Haemophilus influenzae and Moraxella catarrhalis
Staphylococcus aureus: co-pathogen with H. influenzae
Mycoplasma pneumoniae
Viral pneumonia
Pneumonia: Goals of Treatment
Return to baseline respiratory status
Resolution of fever 2-4 days
Resolution of leukocytosis by day 4 of treatment
4 weeks or more to return to normal on chest x-ray
Adult Community-Aquired Pneumonia
Treatment is based on Infectious Diseases Society of America and the American Thoracic Society Consensus Statement (2007)
- I: Previously healthy with no risk factors for drug-resistant S. pneumoniae
- II: Patients with risk factors
- III: Not admitted to the ICU
- IV: ICU Patients
CURB:65 criteria evaluate confusion, uremia, respiratory rate, BP– age 65 years or greater
Adult Community-Aquired Pneumonia: Treatment in Healthy Adults with no risk factors
- Macrolide (level I evidence) (azithromycin or clarithromycin, erythromycin)
- Doxycycline, if allergic
- Treatment for a minimum of 5 days
Adult Community-Aquired Pneumonia: Treatment for Adults with co-morbidities or risk of drug-resistant streptococcal pneumonia
Respiratory fluoroquinolone (moxifloxacin, gemifloxacin, levofloxacin)
Beta lactam plus a macrolide (amoxicillin, amoxicillin/clavulanate, or cefpodoxime, cefuroxime, or parenteral ceftriaxone followed by oral cefpodoxime)
Doxycycline: may be used as an alternative to the macrolide
Adult Community-Aquired Pneumonia: Treatment for Adults older than 60 years with co-morbidities
Outpatient treatment options
Ceftriaxone (Rocephin) 1 g daily via IV or IM, or levofloxacin 500 mg IV daily
May switch to oral therapy once patient can tolerate oral medications
Nursing Home-Acquired Pneumonia
S. pneumoniae is the most common pathogen
S. aureus, H. influenzae, viruses
Anaerobes should be considered
Community-Acquired Pneumonia in Pregnant Women
Main pathogens: S. pneumoniae, H. influenzae, M. pneumoniae, and viruses
Macrolides
- Pregnancy category B: erythromycin, azithromycin
- Pregnancy category C: clarithromycin
Co-morbid conditions or use of recent antibiotics: beta-lactam plus a macrolide
Common Pediatric Pneumonia-Causing Pathogens
S. Pneumoniae is the most common cause of bacterial pneumonia in patients of all ages
- Increase in viral pneumonia with PCV7 vaccine
Infants 4-16 weeks
- Consider Chlamydia
Over 5 years through adolescence
- Consider Mycoplasma
Community-acquired methicillin-resistant Staphylococcus aureus (MRSA)
Virus
Pneumonia: Antibiotic Choices
Children under age 5 years
- Bacterial pneumonia (S. pneumoniae)
- —Amoxicillin: 80-90 mg/kg/day
- —Ceftriaxone: 50 mg/kg/day until able to take oral antibiotics
- —Penicillin allergy: clindamycin or macrolide
- Infant with suspected chlamydial pneumonia
- —Azithromycin 20 mg/kg/day for 3 days OR erythromycin (EryPed) 50 mg/kg for 14 days
Pneumonia- Children Age 5 years or Older: Treatment
Caused by M. pneumoniae or other typical organisms treated most likely with:
- Azithromycin: 10 mg/kg on day 1 and 5 mg/kg on days 2-5
- Clarithromycin: 15 mg/kg/day in two divided doses (max 1 g/day)
- Erythromycin: 40-50 mg/kg/day
Pneumonia: Patient Education
- Pneumonia might be bacterial, viral, or mycoplasmal
- Educate the patient regarding antibiotic prescribed
- Educate the patient regarding hydration, smoking cessation, and rest
- Symptoms of worsening status should be described
- Patients should be told to expect clinical improvement in 48-72 hours
