IN ADULTS:-

ESTABLISH DIAGNOSIS:-

Typical Pneumonia:- Cough, Sputum production, Fever (>38C/>104F) +/- Chest pain (pleuritic),Dyspnoea, Hemoptysis, O/E Tachypnoea, tachycardia, Pleural rub.

Atypical Pneumonia:- More often Subacute (slow onset, 3-4 days), Nonpulmonary symptoms, e.g.myalgias, joint pains, anorexia, fever, chills, headache, non-productive cough; disparity between chest findings and radiological features (more severe).

COMMUNITY ACQUIRED (NON-HOSPITALISED) SIX PRIMARY PATHOGENS

S. Pneumoccus         Legionella

H. Influenzae            Mycoplasma

Moraxella                 Chlamydia

RISK FACTOR FOR EXPOSURE        Disease causing organism

COPD S. Pneumoniae, H. Influenzae, Legionella, GNB

>60y age                                            S. Pneumoniae, H. Influenzae

Smoker                                             H. Influenzae, M. Catarrhalis

Alcoholism                                       S. Pneumoniae, Klebsiella Anaerobes, MTb

<25y age                                            Mycoplasma, Chlamydia

THERAPY:-

 Azithromycin 0.5gm POx1 followed by 0.5gm/d x7-10 d or Clarithromycin or Fluoroquinolones (drugs effective against highly resistant S.Pneumococcus) Sparfloxacin/levofloxacin.

CRITERIA FOR HOSPITAL ADMISSION:- (Only 20% of the Community acquired pneumonias requirehospital admission)

·       AGE >65 YRS

·       Other comorbidities e.g. DM, IHD, COPD, renal disease

·       Unexplained leukopenia < 5000/cu mm.

·       Staph, aureus, GNB or anaerobes

·       Suppurative complications e.g. empyema, arthritis, meningitis

·       Failure of OPD treatment

·       Needing IV antibiotics

·       Tachypnoea >30/mm, Tachycardia>140/min., PaO2< 60mmof Hg., delirium

·       SpO2<90% by pulse oximetry.

DOSAGES OF ANTIMICROBIALS IN TREATMENT OF PNEUMONIAS

 Ampicillin                                         3gm IV q6 hrly

Azithromycin                                   500 mg IV od x3 days

(in severe pneumonias, community acquired) Followed by oral 250 mg bd x 7-10 days

Cefotaoxime                                     1-2 gm IV q8-12 hrly

Ceftazidime                                      2 gm IV q 8 hrly

Ceftriaxone                                      2 gm IV q 12-24 hrly

Cefuroxime                                      750 mg IV 8 hrly

Ciprofloxacin                                   400 mg IV / 750 mg po q 12 hrly

Clindamycin                                     600-900 mg IV q 8 hrly / 300-450 mg q 6 hrly

Erythromycin                                  0.5-1.0 gm IV q 6 hrly

Single dose of ammoglycosides per day has less renal toxicity

 Gentamicin                                       5 mg/kg/ day in 3 divided doses q 8 hrly

Metronidazole                                 500 mg q 8 hrly (po/IV same effect)

Sparfloxacin                                     400 mg x1d, followed by 200mg/d x 10 days

Levofloxacin                                    500 mg once daily

Vancomycin                                     1.0 gm IV q 12 hrly

COMMUNITY ACQUIRED (HOSPITALISED)

PNEUMONIA IN HIV- discussed under DISEASES RELATED TO HIV

GENERAL MEASURES:- EXPECTORANTS, HUMIDIFIED OXYGEN INDICATED BASED ON SpO2.,ANTIPYRETICS

FAILURE TO IMPROVE WITHIN 48-72h OF INITIATION OF ANTIBIOTIC THERAPY:-

 Consider possible causes:-