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Community Acquired Pneumonia
Dr Swapnil Pawar
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
Dr Swapnil Pawar June 28, 2021
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