Pneumonia (main): Difference between revisions

(Created page with "==Background== See Pulm: Pneumonia (Pathogens) ==Work-Up== 1) CBC 2) Chem 7 3) CXR 4) Blood Cx -for admitted pts who will possibly require ICU care during the...")
 
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See Pulm: Pneumonia (Pathogens)
* 3 questions:
 
* Does this pt have pneumonia
* If yes, does this pt need to be admitted
* If yes, admit to the ward or ICU?
   
   


==Work-Up==
==Clinical Presentation==
 


1) CBC
2) Chem 7
3) CXR


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


4) Blood Cx
==Work-Up==
 
    -for admitted pts who will possibly require ICU care during their course




* 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==




- if get abx in 8h- 30% decrease mortality in 30d
* 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)
   
   


Outpt- doxy, macrolide or fluoro
Pseudomonas risk factors:
 
Inpt- Gen med ward- ceph + macrolide or B-lactamase inhibitor + macro, or fluoro alone
 
ICU- ceph or B-lactam + fluoro or macrol
 
Structural lung dz- antipseudom + fluoro
 
Aspiration- fluoro with or without clinda, metro or B-lactam inh


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


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See Pulm: Pneumonia (Port Score)
See Pneumonia (Port Score)


   
   
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Pulm: Pneumonia (Port Score)
Pneumonia (Pathogens)
 
Pulm: Pneumonia  (Pathogens)


   
   
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6/06 MISTRY
UpToDate




Revision as of 23:42, 1 March 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, 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

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