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Community Acquired Pneumonia

Pam Charity, MD Cathryn Caton , MD, MS. Community Acquired Pneumonia. Objectives. Define pneumonia Review criteria for diagnosis Review criteria for admission Review treatment options. Pneumonia. Fever Leukocytosis Infiltrate on CXR. Diagnosis. History Physical Exam Laboratory Data

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Community Acquired Pneumonia

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  1. Pam Charity, MD Cathryn Caton , MD, MS Community Acquired Pneumonia

  2. Objectives • Define pneumonia • Review criteria for diagnosis • Review criteria for admission • Review treatment options

  3. Pneumonia • Fever • Leukocytosis • Infiltrate on CXR

  4. Diagnosis • History • Physical Exam • Laboratory Data • Radiographic findings

  5. Hospital Admission Decision • Severity of Illness Scores – CURB-65 (confusion, uremia, respiratory rate, low blood pressure, age 65 or greater) • Consider other factors – ability to safely and reliably take oral medication, support resources • CURB-65 > or = 2, more intensive treatment

  6. ICU Admission Decision • Major criteria • Septic shock requiring vasopressors • Acute respiratory failure requiring intubation and mechanical ventilation • Minor Criteria • Respiratory rate >30 • PaO2/FiO2 ratio <250 • Multilobar infiltrates • Confusion • BUN >20 • Leukopenia, thrombocytopenia • Hypothermia

  7. Outpatient Treatment • Healthy and no risk factors for drug resistant S. Pneumoniae • Macrolide – azithromycin • Doxycycline

  8. Outpatient Treatment • Patients with • co-morbid conditions – chronic heart, lung, renal disease; DM; ETOH; malignancies; asplenia; immunosuppressing drugs • use of abx within last 3 months • or other risk for drug resistant S. Pneumoniae • Then use • fluoroquinolone • B – Lactam plus macrolide or amoxicillin-clavulanate

  9. Inpatient, non –ICU Treatment • Fluoroquinolone • B-Lactam plus a macrolide • First dose of antibiotics should be administered in the ED after blood cultures are obtained.

  10. Inpatient, ICU Treatment • B-Lactam plus either azithromycin or a fluoroquinolone • For pseudomonas use B-Lactam plus fluoroquinolone or • B-Lactam plus an aminoglycoside and azithromycin or • B-Lactam plus an aminoglycoside and a fluoroquinolone

  11. Switch from IV to Oral • Patients should be switched when • Hemodynamically stable • Clinically improving • Able to tolerate oral medications • Patients should be discharged as soon as clinically stable without other active issues

  12. Duration of Antibiotic Therapy • Minimum of 5 days • Afebrile for 48-72 hours • No more than 1 CAP associated sign of clinical instability

  13. References • IDSA / ATS Guidelines • Clinical Infectious Diseases 2007; 44:S27-72

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