Management Of Community Acquired Pneumonia
Appearance
Diagnostic Tests
[edit | edit source]- CBCD, electrolytes, glucose, BUN, Cr
- ABG on RA
- blood cultures (draw 2 before treatment, at least 10 min. apart)
- sputum gram stain and culture
- CXR (PA and lateral)
- acid fast stain of sputum if cough > 1 month or suspicious CXR for TB
- thoracocentesis if pleural effusions present
- stain, culture, pH, leukocyte count, differential
General Management
[edit | edit source]- analgesics/antipyretics
- ensure adequate hydration
- oxygen therapy to O2 sat ≥ 90%
- consult RT, PT, OT, speech language pathologist, dietician as needed
Hospitalization
[edit | edit source]- When to admit
- Age >65 yrs
- Decreased immunity (cancer, diabetes, AIDS, splenectomy)
- Mental status changes
- Increased A-a gradient
- Two or more lobes involved
- No home
- Organ failure (↑Cr, bone marrow suppression, severe hypotension, liver failure)
- WBC > 30,000/mm3 or < 4000/mm3 (sepsis)
Treatment
[edit | edit source]- if no pathogen identified, empirically treat
- NO COMORBIDITIES: po macrolide or doxycycline
- WITH COMORBIDITIES: po beta-lactam plus macrolide, or fluoroquinolone, quinolones (levofloxacin)
- if suspect ASPIRATION: amoxicillin-clavulanate or levofloxacin and metronidazole
- treat empirically until pathogen identified by sputum or blood culture, then use specific therapy
- OUTPATIENT: treat for 10 - 14 days
- Followup with GP, CXR in 8-12 weeks
- INPATIENT: treatment length based on response to therapy, comorbid illnesses, complications
- usually treat bacterial infections until patient is afebrile for >72 hours
- resolution of respiratory symptoms, fever, PaO2 level, WBC, and findings on serial CXR
- usually treat bacterial infections until patient is afebrile for >72 hours
- give influenza and pneumococcal vaccine on day of discharge
- smoke cessation
Poor prognostic factors
[edit | edit source]- age, men, nursing home
- comorbidities: cancer, liver, CHF, CVDTV
, renal
- O/E: LOC, RR, BP, pulse, temperature
- labs: pH, pO2, ↓hematocrit, ↑BUN, ↓Na, ↑glucose, pleural effusion