Plans for Diagnosis of Community Acquired Pneumonia

CAP Any of the ff: RR ≥30/min PR ≥125/min Temp ≥40 or ≤35°C Suspected aspiration Extrapulmonary evidence of sepsis Unstable comorbid conditions CXR: multilobar, pleural effusion, abscess, progression of lesion to 75% in 24 hours Low risk CAP Out-patient NO YES Any of the ff: 1.Shock or signs of hypoperfusion, hypotension, altered mental state, urine output <30ml/hr 2.PaO 2 50mmHg) at room air YES NO Moderate risk CAP In-patient High risk CAP ICU Philippine Community-Acquired Pneumonia (CAP) Guidelines 2004

Diagnosis Diagnosis is suspected on the basis of clinical presentation and is confirmed by chest x-ray

Chest x-ray almost always demonstrates some degree of infiltrate. In general, no specific findings distinguish one type of pneumonial infection from another, though: – multilobar infiltrates suggest S. pneumoniae or Legionella pneumophila infection – interstitial pneumonia suggests viral or mycoplasmal etiology.

Diagnostic plan CBC CXR Gram stain and culture of the sputum Sputum AFB smear to rule out active TB

Plans for Management of Community Acquired Pneumonia

MANAGEMENT OF CAP Fish D. Pneumonia. PSAP, Pharmacotherapy Self-Assessment Program. Kansas City, Mo.: American College of Clinical Pharmacy, 2002:202.

Management Empirical antibiotic administration – Azithromycin 500 mg IV q 24 h plus β-lactam IV (cefotaxime 1 to 2 g q 8 to 12 h; ceftriaxone 1 g q 24 h) – Macrolides – Antipneumococcal fluoroquinolone po or IV Improvement is manifested by decreased cough and dyspnea, defervescence, relief of chest pain, and decline in WBC count. Failure to improve should rise suspicion of: – an unusual organism – Resistance to antibiotic – Empyema – coinfection or superinfection with a 2nd infectious agent

Management Supportive care: – Fluids – Antipyretics Advise to refer back to DOTs with X-ray and sputum AFB results as outpatient