Pneumonia Treatment Introduction

Pneumonia it means consolidation is defined as Inflammation in lung, characterized by accumulation of secretion and inflammatory cells in alveoli.

Table of contents

Pneumonia Treatment Introduction

Clinical features Of Pneumonia:

Frequent symptoms:

Fever- high grade, associated with chills and rigor.
Cough

Productive- mucoid, purulent or blood tinged, rusty.

Non productive

Pleuritic chest pain.
Dyspnoea.

Less frequent symptoms:

Nausea, vomiting, diarrhoea- more common with viral pneumonia
Fatigue
Headache
Arthralgia

Physical Examination:

Febrile, ill-looking
Tachypnoea
Tactile/vocal fremitus increased (consolidation) Decreased (pleural effusion) Dull on percussion (consolidation/pleural effusion)
Crepitations
Bronchial breathing
Pleural rub

Investigations:

Sputum gram satin
Blood culture
Sputum culture
If an atypical organism is suspected:

urine Legionella antigen

Respiratory secretions may be sent for Enzyme Immunoassay, Immunofluorescence, P.C.R

Chest Xray PA View
ABG
SPO2

Indication for Hospitalization of patient :

CURB 65

C- Confusion

U- Urea>40 mg/dL

R- Respiratory rate >30/ min

B- Blood pressure Systolic <90mmHg or Diastolic <60mmHg

Age- 65

Score:

0: Home

1-2: Hospitalize

>3: ICU admission

Empirical Antibiotic Therapy For Pneumonia Treatment

OP based Pneumonia Treatment

Previously healthy and no antibiotics Comorbidities (+) Antibiotics

In past 3 months in past 3 months

Oral Macrolides or oral Tetracyclines Beta Lactum + Macrolide

Non ICU Management

Respiratory Fluoroquinolone Beta Lactams(IV) + macrolide

(Oral or IV) (oral or IV)

ICU management

Beta Lactams (IV) + Macrolides or Respiratory Fluoroquinolone

Macrolide:

Azithromycin 500mg OD, P.O once then 250 mg OD X 3-5 days

Tetracyclines:

Doxycycliness 100 mg BD x 5-7 days.

Beta Lactams:

Amoxicillin 1gm TID or Moxclav 1gm BD

Cefotaxime 1-2 g IV Q8H

Ceftriaxone 1-2 g IV OD

Ampicillin 1-2 g IV Q4H- Q6H

Respiratory Fluoroquinolones:

Moxifloxacin 400 mg OD P.O/IV or Levofloxacin 750mg OD P.O/ IV.

Note:

Antibiotics need to be appropriately changed as per culture results.

Respiratory Fluoroquinolones should only be used as second line and only if

the organism is sensitive.