Plans for Diagnosis of Community Acquired Pneumonia

CAP

Any of the ff:RR ≥30/min

PR ≥125/minTemp ≥40 or ≤35°C

Suspected aspirationExtrapulmonary evidence of

sepsisUnstable comorbid conditions

CXR: multilobar, pleural effusion, abscess, progression of lesion to 75% in 24 hours

Low risk CAP

Out-patient

NO

YES

Any of the ff:1. Shock or signs of

hypoperfusion, hypotension,

altered mental state, urine output

<30ml/hr2. PaO2 < 60mmHg or

acute hypercapnea (PaCO2 > 50mmHg)

at room air

YES

NO

Moderate risk CAP

In-patient

High risk CAP

ICU

Philippine Community-Acquired Pneumonia (CAP) Guidelines 2004

Diagnosis

• Diagnosis is suspected on the basis of clinical presentation and is confirmed by chest x-ray

• Chest x-ray almost always demonstrates some degree of infiltrate.

• In general, no specific findings distinguish one type of pneumonial infection from another, though:– multilobar infiltrates suggest S. pneumoniae or

Legionella pneumophila infection – interstitial pneumonia suggests viral or

mycoplasmal etiology.

Diagnostic plan

• CBC• CXR• Gram stain and culture of the sputum• Sputum AFB smear to rule out active TB

Plans for Management of Community Acquired Pneumonia

MANAGEMENT OF CAP

Fish D. Pneumonia. PSAP, Pharmacotherapy Self-Assessment Program. Kansas City, Mo.: American College of Clinical Pharmacy, 2002:202.

Management

• Empirical antibiotic administration– Azithromycin 500 mg IV q 24 h plus β-lactam IV (cefotaxime 1 to 2 g q

8 to 12 h; ceftriaxone 1 g q 24 h)– Macrolides– Antipneumococcal fluoroquinolone po or IV

• Improvement is manifested by decreased cough and dyspnea, defervescence, relief of chest pain, and decline in WBC count.

• Failure to improve should rise suspicion of: – an unusual organism– Resistance to antibiotic– Empyema– coinfection or superinfection with a 2nd infectious agent

Management

• Supportive care: – Fluids– Antipyretics

• Advise to refer back to DOTs with X-ray and sputum AFB results as outpatient