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CAP management
Management of Community Acquired Pneumonia
| Question | Answer |
|---|---|
| What does the term penumonia mean? | Inflammation in the parenchymal structures of the lung in the lower respiratory tract, such as the alveoli and the bronchioles |
| What is typical pneumonia? | Bacteria multiply extracelluarly in the alveoli, inflammation and exudation of fluid fills the air filled spaces of the alveoli resulting in edema. |
| What is atypical pneumonia? | Viral and mycoplasma infections, involve the alveolar septum and interstitium of the lung |
| How is acute bacterial pneumonia classified? | Bronchopneumonia: patchy consolidation involving more than one lobe Lobar pneumonia: consolidation of a part or all of a lung lobe |
| What types of micro-organisms can cause pneumonia? | Bacteria, viruses, fungi |
| What are the different types of pneumonia? | Community acquired, nursing home acquired, aspiration, hospital acquired pneumonia |
| What are the risk factrs for acquiring pneumonia? | 65+ yrs, children < 2 yrs, chronic disease (heart, seizure disorders), alcoholism, asthma, COPD, smoking, immunosuppression, dysphagia, Indigenous background |
| How can you prevent pneumonia? | Annual flu vax, pneumococcal vax, stop smoking, treat comorbidities, medication reviews, good oral hygiene, early mobilisation during hospital stay. |
| What are the signs and symptoms of pneumonia? | Fever 38+, dyspnoea, rigors, night sweats, new onset cough, chest pain/discomfort, pleuritic chest pain, elevated respiratory rate, sputum production, |
| Why may sputum colour be helpful in diagnosing pneumonia? | Colour can suggest a particular pathogen. rust = S pneumoniae, red jelly = Klebsiella, green = pseudomonas |
| What signs and symptoms may present in elderly people? | Reduced mobility, falls, mental confusion, new onset incontinence, loss of apetite, altered sleep-wake cycles |
| What tools can be used to diagnose penumonia? | Chest X-ray, pulse oximetry, respiratory rate, FBC, BP, urine testing, sputum gram stains and cultures, nucleic acid amplification testing, blood culture |
| Which of the diagnostic tools is crucial for pneumonia diagnosis? | Chest x -ray Alveoli infected with inflammatory exudate, bacteria and white cells will look like an opaque area on the lung |
| How is pneumonia classified? | By pathogen, by place of acquisition, by means of acquisition, by chest x-ray appearance, by severity |
| What is the definition of CAP? | Pneumonia in individuals who are not hospitalised, or hospitalised for < 48hrs, not including those who are: immunocompromised, have chronic suppurative lung disease, residents of aged care facilities |
| What are the common pathogens associated with CAP? | Stretococcus pneumoniae, mycoplasma pneumoniae chlamydophila pneumoniae, legionella pneumophilia, respiratory viruses, haemophilius influenzae |
| How is CAP managed once confirmed? | CORB, SMART COP to determine severity Where should treatment take place Which antibiotic to use |
| How is the SMART COP tool interpreted? | 0-2 points = low IRVS need, 2% risk of death 3-4 points = 5-13% risk of death, moderate IRVS need 5-6 points= high IRVS need, 11-18% risk of death 7+ points = very high IRVS need, 33% chance of death |
| What is CORB? | C=acute confusion O= oxygen saturation 90% or less R=respiratory rate 30 breaths or more p/minute B= systolic blood pressure less than 90mmHG, or diastolic BP 60mmHG or less |
| How is CORB interpreted? | Person has severe CAP if two or more features are present |
| A person with CAP should be treated in a hospital if they have any of the following: | tachypnoea (res. rate of 22+ breaths/min ) HR 100+bpm hypotension acute onset confusion oxygen saturation <92% multilobar shown on chest x-ray blood lactate conc'n 2+mmol/L |
| A person with CAP should be treated in ICU if they have any of the following: | Res. Rate 30+ breaths/minute O2 saturation <90%, PaO2 < 60mmHG, or PaO2/FO2 < 250 multilobar, rapid progression shown on chest x-ray hypotension acute onset of confusion poor peripheral vision mottled skin acute oliguria, elevated serum creatinine |
| How is mild CAP treated in an oiutpatient setting? | Amoxycillin: 1g tds for 5-7 days Or doxycycline 100mg 12 hourly for 5-7 days If no improvement in 48 hours: Amox + Dox, same doses as above In pregnancy: Clarithromycin 500mg 12 hrly for 5-7 days instead of doxy |
| What is the doxycyline reserved for in mild CAP? | Treating atypical pathogens |
| How is moderate CAP treated? | Benzylpenicillin 1.2g IV 6 hourly + doxycyline 100mg orally 12 hourly If doxy C/I, replace with clarithromycin 500mg orally 12 hourly |
| How long should treatment last for a person with moderate CAP improves within 2-3 days? | Treat for 5 days |
| How long should a person with moderate CAP be treated if clinical resposne is low? | Treat for 7 days |
| When can moderate CAP be switched to oral treatment? And how is it managed after switching? | Clinical improvement Fever resolved or improving No unexplained haemodynamic instability tolerating oral intake without malabsorption Suitable oral formulation is available Treat as per mild CAP guidelines |
| How is severe CAP treated in all regions? | Cetriaxone 2g IV d or cefotaxime 2g IV 8 hourly Plus azithromycin 500mg IV d |
| When can severe CAP be switched to moderate CAP therapy? | Once patient has shown significant improvement |
Created by:
LDM
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