PNEUMONIA Flashcards
Types of microbes that can cause pneumonia
Bacteria
Virus
Fungi
CURB-65 score parameters
Confusion
Uremia >7mmol/l
Respiratory rate > 30 in adults and >50 in children
Blood pressure, systolic<90 or diastolic<60
Age <5yrs or >65yrs
Different approaches managing pneumonia patient based on their CURB65 scores
0-1 outpatient management
2-3 short inpatient hospitalisation
>3 admit and consider intensive care
Additional factors that warrant hospitalisation in pneumonia patients
Comorbidities such as chronic lung disease, heart failure or renal disease
Extensive disease, multiple lobes involved
Low oxygen saturation SpO2, < 92% on room air
Severe tachycardia
4 Major types of pneumonia
Community acquired pneumonia CAP
Hospital acquired pneumonia
Aspiration pneumonia
Ventilator associated pneumonia
Other types of pneumonia
Viral
Pneumocystis jirovecii pneumonia
Other fungal pneumonia in immunocompromised patients
Bacterial causes of community acquired pneumonia
Streptococcus pneumoniae
Streptococcus pyogenes
Haemophilus influenzae
Klebsiella pneumoniae
Mycoplasma pneumoniae
Legionella pneumoniae
Staphylococcus aureus
Risk factors for staph aureus CAP
Children after viral illness like measles
Diabetes
Elderly during ‘flu’ epidemics
Consitutional symptoms of pneumonia
Fever
Malaise
Chills
Sweating
Muscle aches
Respiratory symptoms of pneumonia
Productive cough
Dyspnoea
Pleuritic chest pain
Haemoptysis
Signs of pneumonia
Fever
Tachypnea
Tachychardia
Use of accessory muscles of respiration and flaring of the nasal margins
Signs of consolidation or pleural effusion on chest examination
Restlessness
Confusion
Drowsiness
Low blood oxygen saturation by pulse oximetry < 92%
Signs of pneumonia that occur only in children
Grunting
Lower chest wall indrawing
Complications of pneumonia
Pleural effusion
Lung abscess
Empyema
Pericardial effusion
Pericarditis
Pneumothorax
Septicemia
Adult respiratory distresssyndrome
Meningitis
Investigations conducted in pneumonia
FBC
C-reactive protein
Chest X-ray
Sputum gram stain
Sputum culture and sensitivity
Ziehl-Neelsen stain for acid-fast bacilli (to exclude TB)
Blood culture and sensitivity
Blood urea and electrolytes
First line therapy for low severity pneumonia CURB65<2 in adults
Amoxicillin 1g 8hourly for 7 days
and
Azithromycin 500mg daily for 6 days
or
Erythromycin 500mg 6 hourly for 7 days
First line therapy for low severity pneumonia CURB65<2 in children
Amoxicillin for 7days
5-12 yrs 500mg 8hrly
1-5 yrs 250mg 8hrly
6months-1 yr 125mg 8hrly
and
Azithromycin 10mg/kg for 6 days
or
Erythromycin 6hrly for 7days
8-18yrs 250-500mg
2-8yrs 250mg
6months-2yrs 125mg
Second line therapy for low severity pneumonia CURB65<2 in adults
Cefuroxime 500mg 12 hourly for 7 days
or
Doxycycline 100mg 12hourly for 7-14days
Second line therapy for low severity pneumonia CURB65<2 in children
Cefuroxime
3 months-12 years; 30 mg/kg/day in two divided doses for 7
days
> 12 years; 250-500 mg 12 hourly for 7 days
or
Doxycycline 100 mg 12 hourly for 7-14 days
First line treatment for Hospitalised patient: Severity score, ≥ 2 in children
Oxygen + IV fluids + Paracetamol+
IV Amoxicillin/Clavulanic
3 months-18 years; 30 mg/kg 8 hourly, max. 1.2 g 8 hourly for
7-10 days
< 3 months; 30 mg/kg 12 hourly for 7-10 days
+
Azithromycin oral
10 mg/kg once daily for 3-7 days
First line treatment for Hospitalised patient: Severity score, ≥ 2 in adults
Oxygen + IV fluids + Paracetamol+
IV Amoxicillin/Clavulanic acid 1.2 g 8 hourly for 7-10 days
+
Azithromycin oral
500 mg daily for 3-7 days
or
Azithromycin IV
500 mg daily for 3 days, continue with oral to complete 7 days
Second line treatment for Hospitalised patient: Severity score, ≥ 2 in children
Ceftriaxone, IV,
All ages 25 mg/kg 12 hourly (max. 75 mg/kg daily)
and
Azithromycin (IV not used in children for pneumonia, use oral
Target for oxygen saturation
> 92%
IV fluids used in pneumonia
Normal saline
Dextrose saline
Second line treatment for Hospitalised patient: Severity score, ≥ 2 in adults
IV Ceftriaxone 2g daily for 7-10 days
and
Azithromycin IV
Treatment for aspiration pneumonia in adults
IV Ceftriaxone or Amoxicillin/Clavulanic acid or IV Ciprofloxacin
and
IV Metronidazole or
IV Clindamycin
Dose for IV clindamycin in aspiration pneumonia
Adults
300-600 mg 6 hourly for 7 days
Children
3-6 mg/kg 6 hourly for 7 days
Dose for IV Ceftriaxone in aspiration pneumonia
Adult
2 g daily for 7-10 days
Children
All ages 50-75 mg/kg/day in divided 12 hourly doses
Dose for IV Amoxicillin/Clavulanic acid in pneumonia
Adults
1.2 g 8 hourly for 7-10 days
Children
3 months-18 years; 30 mg/kg 8 hourly, max 1.2 g 8 hourly for
7-10 days
< 3 months; 30 mg/kg 12 hourly for 7-10 days
Dose for IV Ciprofloxacin in pneumonia management
Adults
400 mg 8-12 hourly for 7 days
Children
10 mg/kg (max. 400 mg) 12 hourly for 7 days
Dose for IV Clindamycin in pneumonia management
Adults
300-600 mg 6 hourly for 7 days
Children
3-6 mg/kg 6 hourly for 7 days
Dose for IV Metronidazole in aspiration pneumonia
Metronidazole, IV,
Adults
500 mg 8 hourly for 7 days
Children
7.5 mg/kg 8 hourly for 7 days
