Pneumonia (main): Difference between revisions
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==See Also== | ==See Also== | ||
[[Pneumonia (Pathogens)]] | [[Pneumonia (Pathogens)]] | ||
[[Pneumonia (Port Score)]] | |||
[[Pneumonia (Peds)]] | |||
==Source== | ==Source== |
Revision as of 18:48, 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
- Unhealthy
- Respiratory fluoroquinolone alone OR macrolide + beta-lactam
Inpatient
- Ward
- Respiratory fluoroquinolone alone OR macrolide + beta-lactam
- ICU, low risk of pseudomonas
- Beta-lactam + (macrolide OR respiratory fluoroquinolone)
- ICU, risk of pseudomonas
- Cefipime, imipenem, OR piperacillin-tazobactam + IV cipro/levo
- Cefipime, imipenem, OR piperacillin-tazobactam + gent + azithromycin
- Cefipime, imipenem, OR piperacillin-tazobactam + gent + cipro/levo
Pseudomonas risk factors
- Alcoholism
- Immunosuppression (incl. steroids)
- Structural lung disease
- Malnutrition
- Recent abx
- Recent hospital stay
Disposition
See Also
Pneumonia (Pathogens) Pneumonia (Port Score) Pneumonia (Peds)
Source
UpToDate