Pneumonia (main)

Background

• 3 questions:
• Does this pt have pneumonia
• If yes, does this pt need to be admitted
• If yes, admit to the ward or ICU?

Clinical Presentation

• Fever, chills, pleuritic CP, productive cough
• Fever is seen in 80%
• Tachypnea
• Most sensitive sign in elderly

Work-Up

• CXR
• CBC
• Chemistry
• If pt to be admitted:
• Blood cultures (required if pt may require ICU during their course)
• Sputum staining
• If concern for particular organism

Treatment

• Abx within 6 hours
• 10-14 days
• Outpatient, healthy
• Macrolide OR doxycycline
• Outpatient, unhealthy
• Respiratory fluoroquinolone alone OR macrolide + beta-lactam
• History of cardiopulmonary disease
• Some high risk factors
• Abx w/in 3 months
• Port Class 1 or 2
• Inpatient, ward
• Respiratory fluoroquinolone alone OR macrolide + beta-lactam
• Inpatient, ICU, risk of pseudomonas
• Cefipime, imipenem, OR piperacillin-tazobactam + IV cipro/levo
• OR
• Cefipime, imipenem, OR piperacillin-tazobactam + gent + azithromycin
• OR
• Cefipime, imipenem, OR piperacillin-tazobactam + gent + cipro/levo
• Inpatient, ICU, low risk of pseudomonas
• Beta-lactam + (macrolide OR respiratory fluoroquinolone)

Pseudomonas risk factors:

• Alcoholism
• Immunosuppression (incl. steroids)
• Structural lung disease
• Malnutrition
• Recent abx
• Recent hospital stay

Disposition

See Pneumonia (Port Score)

See Also

Pneumonia (Pathogens)

Source

UpToDate