Pneumonia

Question 1

Pneumonia (community-acquired):
NG 138 notes

Answer 1

Signs and Symptoms:
Cough, chest pain, dyspnoea, fever

Management:
Offer antibiotics - take in to account:
* Severity assessment for adults
* Severity of symptoms/signs in children and young ppl
* Risk of complications
* Local antimicrobial resistance
* Recent antibiotic use
* Recent microbiological results
Start treatment ASAP after diagnosis within 4 hrs (1 hr if sepsis sus).
Oral - 1st line. IF IV given review by 48 hrs and consider switch to oral.
Children & young in hospital with severe case or comorbidity consider sending sample for testing.

Advice:
* Possible AEs of antibiotics
* length of symptoms likely to last
* Get medical help if: Symptoms worsen rapidly/significantly OR symptoms dont improve within 3 days OR person becomes systemically unwell.

Reassessment:
* If symptoms dont improve as exp or worsen rapidly/significantly
* be aware of non bacterial causes (flu)
* IF sample sent: review choice of drug AND consider changing
* Send sample if no improvement and hasn’t been already done.

Referral and seeking specialist advise:
Refer adults to hospital IF:
- Symptoms/signs suggesting more serious illness or condition (sepsis)
- OR improvement not as expected.
Consider referral IF:
- Bacteria resistant to Oral antibiotics OR - Cant take Oral meds
- Consider sending young ppl with Community pneumonia to hospital to get specialist paediatric advise.

DIAGRAM NG138 FOR TREATMENT (in Phone/NICE)

Question 2

Pneumonia (hospital-acquired) NG 139 notes

Answer 2

Signs and Symptoms:
Cough, chest pain, dyspnoea, fever

Management:
* If signs/symptoms start within 48 hrs of admission follow community acquired pneumonia advise
* Offer antibiotic take in to account:
- Severity of symptoms/signs
- Number of Hospital days before symptoms onset
- Risk of complications occurring
- Local hospital/ward based antimicrobial resistance data
- Recent antibiotic use
- Recent microbiological results
- Recent contact with a health or social care setting before admission
- Risk of adverse effects with broad spectrum antibiotics
* start treatment within 4 hrs of diagnosis (1hr if sepsis suspected)
* Oral 1st line if IV not needed
* If IV given review in 48 hrs - consider switch to oral
* Send sample for testing

Reassessment and specialist advice:
* When microbiological test results available:
- Review antibiotic choice AND
- Change according to results.
* Reassess ALL if symptoms dont improve as exp or worsen rapidly/significantly.
* Seek specialist for ALL if have:
- Symptoms not improving as expected with antibiotics OR
- Multi drug resistant bacteria

CHOICE OF ANTIBITOIC:
Consider starting for ALL showing signs/symptoms who are NOT at high risk of resistance within 3-5 days of hospital admission.

CHECK DIAGRAM ON NICE/PHONE