Pneumonia (main): Difference between revisions
No edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | ==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== | ==Clinical Presentation== | ||
* Fever, chills, pleuritic CP, productive cough | * Fever, chills, pleuritic CP, productive cough | ||
* Fever is seen in 80% | ** Fever is seen in 80% | ||
* Tachypnea | * Tachypnea | ||
* Most sensitive sign in elderly | ** Most sensitive sign in elderly | ||
==Work-Up== | ==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== | ==Treatment== | ||
* Abx within 6 hours | * Abx within 6 hours | ||
* 10-14 days | * 10-14 days | ||
===Outpatient=== | |||
#Healthly | |||
## Macrolide OR doxycycline | |||
#Outpatient, unhealthy | |||
* Respiratory fluoroquinolone alone OR macrolide + beta-lactam | * Respiratory fluoroquinolone alone OR macrolide + beta-lactam | ||
* History of cardiopulmonary disease | * History of cardiopulmonary disease | ||
* Some high risk factors | * Some high risk factors | ||
* Abx w/in 3 months | * Abx w/in 3 months | ||
* Port Class 1 or 2 | * Port Class 1 or 2 | ||
* Inpatient, ward | * Inpatient, ward | ||
* Respiratory fluoroquinolone alone OR macrolide + beta-lactam | * Respiratory fluoroquinolone alone OR macrolide + beta-lactam | ||
| Line 50: | Line 45: | ||
* Inpatient, ICU, low risk of pseudomonas | * Inpatient, ICU, low risk of pseudomonas | ||
* Beta-lactam + (macrolide OR respiratory fluoroquinolone) | * Beta-lactam + (macrolide OR respiratory fluoroquinolone) | ||
Pseudomonas risk factors | ===Pseudomonas risk factors=== | ||
# Alcoholism | |||
# Immunosuppression (incl. steroids) | |||
# Structural lung disease | |||
# Malnutrition | |||
# Recent abx | |||
# Recent hospital stay | |||
==Disposition== | ==Disposition== | ||
See Pneumonia (Port Score) | See Pneumonia (Port Score) | ||
==See Also== | ==See Also== | ||
Pneumonia (Pathogens) | Pneumonia (Pathogens) | ||
==Source== | ==Source== | ||
UpToDate | UpToDate | ||
[[Category:Pulm]] | [[Category:Pulm]] | ||
Revision as of 18:15, 10 June 2011
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
- Healthly
- 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