Community Acquired Pneumonia

Community-Acquired Pneumonia

Written by – Dr Andrew Lam

Scores for determination of pneumonia severity: 

CURB-65

 C – Confusion (1 point)

 U – Urea > 7mmol/L (1 point)

 R – Respiratory Rate > 30 (1 point)

 B – Systolic BP < 90 or Diastolic BP < 60 (1 point)

 65 – > 65 years old (1 point)

 0 = Mild

 1 = Moderate

 > 2 = Severe

SMART-COP

S – Systolic BP <90 mmHg (2 points)

M – Multiple lobes involved on chest x-ray (1 point)

A – Albumin level less than 35 g/L (1 point)

R – RR > 25 in those who are < 50 y/o (1 point)

      RR > 30 in those who are > 50 y/o (1 point) 

T – Tachycardia of > 125 BPM (1 point)

C – Confusion (1 point)

O – < 50 y/o: PaO2 <70 mmHg or O2 Saturation ≤93% or PaO2/FiO2 <333 if receiving O2 (2    points)

      > 50 y/o: PaO2 <60 mmHg or O2 Saturation ≤90% or PaO2/FiO2 <250 if receiving O2 (2 points)

P – pH < 7.35 (2 points) 

0-2 points = low risk

3-4 points = moderate risk

5-6 points = high risk

7-11 points = very high risk

Antibiotic Regimens For Pneumonia

Community-Acquired:

Mild – Amoxicillin (if suspecting typical organism) or Doxycycline (ff suspecting atypical organism)

Moderate – Benzypenicillin + Doxycycline

Severe – Ceftriaxone + Azithromycin

Hospital-Acquired: 

Mild/Moderate – Augmetin (Oral) or Ceftriaxone (IV)

Severe – Tazocin +/- Gentamicin or Vancomycin if suspecting Gram -ve or +ve organism respectively

Ventilator-Associated:

Tazocin +/- Gentamicin or Vancomycin if suspecting Gram -ve or +ve organism 

Aspiration

Attempt to differentiate between aspiration pneumonitis vs. aspiration pneumonia

Treat as per community or hospital-acquired pneumonia. If nil improvement after 24-48 hours, commence amoxicillin + metronidazole or augmentin if the patient is not already on a broad-spectrum antibiotic. If already on broad-spectrum antibiotics (i.e. augmentin, tazocin, meropenem), then consult specialist advice.

Chest X-Ray Findings of Pneumonia

        Lobar Pneumonia (R. Upper Lobe)                                   Bronchopneumonia

References

Electronic Therapeutic Guidelines. Respiratory Tract Infections – Pneumonia. eTG Complete. Retrieved 3rd July 2021 from https://tgldcdp.tg.org.au.acs.hcn.com.au/viewTopic?topicfile=pneumonia-diagnosis-follow-up

Knipe, H. Lobar Pneumonia. Radiopaedia. Retrieved 3rd July 2021 from https://radiopaedia.org/articles/lobar-pneumonia

Knipe, H. Bronchopneumonia. Radiopaedia. Retrieved 3rd July 2021 from https://radiopaedia.org/articles/bronchopneumonia

Yealy, D.M., Fine, M.J. Community-acquired pneumonia in adults: assessing severity and determining the appropriate site of care. UpToDate. Retrieved 3rd July 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/community-acquired-pneumonia-in-adults-assessing-severity-and-determining-the-appropriate-site-of-care