Pneumonia (CAP And HAP) Flashcards
Classification of pneumonia and definitions
CAP- pneumonia developing in patients with no contact to medical facility
HAP-pneumonia developing >48hours of hospital admission
Ventilation associated (VAP)-pneumonia developing >48 hours after intubation and mechanical ventilation
Risk factors for CAP
Age >65years
DM
Asplenia
Smoking/alcohol use
Renal, cardiovascular, liver , pulmonary disease
Risk factors for HAP
Aspirations
COPD, coma
Antacids, PPI, H2 antagonist
Supine position
>60years
Head trauma
MDR risk ie (MRSA, MDR pseudomonas) if IV use within 90 days
Causative pathogens
S. Pneumonia, h. Influenza, legionella species, M. Pneumonia, C. Pneumonia
Pathophysiology
Microorganisms gain access to lower respiratory tract by:
Inhalation of aerosols
Lungs via bloodstream from extra pulmonary site
Aspiration (anearobes)
Impaired mucociliary clearance, alveolar macrophage impaired
Pathogens likely for paediatric group
Due to virus, adenovirus, parainfluenza,
Bacterial S.pneumonia, S. Aeureus, A streptococcus
Clinical presentation Pneumonia
Pleuritic chest pain
Onset of fever,chills, productive cough, dyspnea
Hemoptysis or rust color sputum
Tachycardia
Crackles on lung expansion
Diminished breath sounds
Give diagnostic measures pneumonia
Lab tests-cbc for leukocytosis
ABG- low oxygen saturation
Chest radiograph-denser lobar
Cultures and sensitivity
Renal -increased Creatinine, BUN
Blood cultures of concern of sepsis
Non Pharmacological management
Humidified oxygen for hypoxemia
Bronchodilators is salbutamol when bronchospasm is present
Adequate hydration
IV fluids
Optimal nutrient support
Fever control ie tepid sponging and use of analgesics
Give empiric therapy for previously healthy no risk factors ie comorbidities
Macrolide monotherapy- azithromycin 500mg q24hours 7-10 days
Or tetracycline doxycycline 100mg q12h
Explain rationale for combination therapy for patients with comorbidities
Add beta lactam(to prevent superinfection by multiple pathogens in patients with comorbidities ) combination aids to cover resistant strains ie typical and atypical ie mycoplasma , legionella , chlamydia
Give treatment for patients with comorbidities
Augmentin - 500mg q8h 7-10 days
Cefuroxime 500mg q8h IV/IM
Ceftazidime 1-2g q8-12h IV
Plus
Azithromycin 500mg day 1 , 250 mg day 2-4 (covers legionella)
Or monotherapy
Levofloxacin 500mg q24h 5-10days (covers legionella)
Discuss CURB 65 score
RR >30 breaths /minute
BP systolic <90 mmHg diastolic <60 mmHg
Age >65 years
Uremia sign of AKI
0= low risk manage outpatient
1-2= consider hospitalization
3-4=high risk hospitalization
Treatment for elderly with macrolide resistant S.pneumonia
Piperacillin/tazobactam 3.375g q6h
Ceftazidime 1-2g q8h
Treatment of pneumonia
causative organism=MRSA
Vancomycin 15-20mg/kg q8-12h
Linezolid children 12 years and older 600mg oral/IV q12h for 10-14 days
Ceftaroline 600mg q12h IV