Outpatient management for Community-acquired (pneumonia)

                     Pneumonia

              Outpatient management for

  Community-acquired pneumonia

 Common pathogens

·     Typical

·     Streptococcus pneumoniae

·     Haemophilus influenzae

·     Moraxella catarrhalis

·     Atypical

·     Legionella pneumophila

·     Mycoplasma pneumoniae

·     Chlamydia pneumoniae

        Disease overview

·     Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide.

·     Common symptoms: Fever, Dyspnea, Cough (with or without sputum), Chills, Pleuritic chest pain, Fatigue.

·     Workup: Chest X-ray to demonstrate infiltrate on chest; Define severity using pneumonia severity index; Microbiologic testing (if required)

What to expect?

· Disease overview

· Common pathogens

· Outpatient treatment

· Treatment goal

· Common side effect

· Test your knowledge

· TL;DR

 

Disease overview

 

         

   Treatment goal

·     Target Streptococcus pneumoniae (the most common and virulent bacterial CAP pathogen)

·     Target Atypical pathogens

·     In patient with co-morbidities,

Coverage is expanded to treat:

·     Haemophilus influenzae

·     Moraxella catarrhalis

·     Methicillin-susceptible S. aureus

Key side effects

·     Amoxicillin / Augmentin

·     Diarrhea may be related to C. diff

·     Dermatologic reactions caused by beta- lactam allergy

·     Macrolide

·     Hepatoxicity

·     QT prolongation

·     Doxycycline

·     Bone growth suppression

·     Dental discoloration

Test your knowledge

·     Can you list out one more pathogen that might cause community-acquired pneumonia?

Ø Community-acquired pneumonia is defined as pneumonia that is acquired outside the hospital. The most commonly identified pathogens are Streptococcus pneumoniae, Haemophilus influenzae, atypical bacteria (ie, Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella species), and viruses. Symptoms and signs are fever, cough, sputum production, pleuritic chest pain, dyspnea, tachypnea, and tachycardia. Diagnosis is based on clinical presentation and chest x-ray. Treatment is with empirically chosen antibiotics. Prognosis is excellent for relatively young or healthy patients, but many pneumonias, especially when caused by S. pneumoniae, Legionella, Staphylococcus aureus, or influenza virus, are serious or even fatal in older, sicker patients.

·     What causes community-acquired pneumonia?

Ø Many different types of germs can cause pneumonia. But certain types cause CAP more often. Worldwide, Streptococcus pneumoniae is a bacteria that is most often responsible for CAP in adults. Some other common bacteria that cause CAP are:

           Haemophilus influenzae

          Mycoplasma pneumoniae

          Chlamydia pneumoniae

          Legionella

         Gram-negative bacilli

         Staphylococcus aureus

·     Who is at risk for community-acquired pneumonia?

Certain things may raise your risk for CAP. Some of these are:

Smoking

Weak immune system, such as from drug treatment or a health problem like diabetes, cancer, or HIV

Other lung problems such as chronic obstructive pulmonary disease

Other health problems such as kidney failure

Use of certain medicines, including proton-pump inhibitors

Heavy alcohol use

You also have a higher risk if you come into contact with other people who have pneumonia.

 

TL ; DR

·     Cap is a leading cause of morbidity and mortality worldwide

·     Symptoms include cough, fever and

dyspnoea

·     Most common causative pathogen is 

Streptococcus pneumoniae

·     Outpatient empirical treatment is oral

Amoxicillin + Macrolide or Doxycycline.

·     Use Augmentin instead of Amoxicillin for patients with co-morbidities.

 

CAP Therapy – Outpatient (Low Risk)

CAP Therapy – Inpatient (High Risk)