Treatment of pneumonia Flashcards
What is pneumonia?
A lower respiratory tract infection usually with:
- fever
- symptoms/signs in chest
- abnormal CXR
How is penumonia transmitted?
Aerosolisation
Aspiration
- micro = oropharyngeal secretions
- gross = usually anaerobes/gram -ves from GIT
Haematogenous spread
Why do aspiration pneumonias occur?
Occur in those patients who cannot protect their airways
- anaesthetised
- CVA
- under the influence of alcohol
What are the predisposing factors for pneumonia?
Elderly
Institutions (nasocomial infection)
Alcoholism
Poor nutrition
Immunocompromised
What are the symptoms of pneumonia?
Fever
Cough
Pain
SOB/dyspnoea
What are the signs of pneumonia?
Consolidation
- decreased percussion note
- increased tactile and vocal fremitus
Crackles
Bronchial breathing (harsh sounds of a blowing quantity)
What is the measurement used to score the severity of pneumonia?
CURB 65
Confusion Urea > 7 Respiratory rate > 30 Blood pressure < 90/60 > 65 years old
> 2 = admit to ITU
What investigations should be done for suspected pneumonia?
Sputum
- AFB smear (test for TB)
- MC&S (to ID organism)
Urine
- legionella antigen
- output
Blood
- MC&S
- Urea (test of kidney function)
- Serology (identify antibodies)
- WBC
ECG
Radiography
- XCR
- CT (more sensitive)
Bronchoscopy and brushing if NAD
Which empirical antibiotic should be used for uncomplicated pneumonia?
Amoxicillin (oral)
+
Clarithromycin (oral)
Which empirical antibiotic should be used for complex/severe pneumonia?
Co-amoxiclav / Cefuroxime (IV)
+
Clarithromycin (oral)
Which antibiotics should be used for atypical pneumonia?
Clarithromycin
Rifampicin (IV)
Tetracycline
Which antibiotics should be used for cavitation pneumonia?
Cefuroxime (IV)
Metranidazole (IV)
Flucloxacillin (IV)
Which antibiotics should be used for aspiration pneumonia?
Co-amoxiclav
Metranidazole
When should a pneumonia patient be admitted to ITU?
When CURB 65 > 2
What are the possible complications of pneumonia?
Lung abcess
Empyema
Bronchiectasis (abnormal widening of the bronchi + branches)
Acute respiratory distress syndrome
