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
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