Pneumonia (main)

Background

3 questions:

1. Does this pt have pneumonia?
2. If yes, does this pt need to be admitted?
3. If yes, admit to the ward or ICU?

Clinical Presentation

• Fever, chills, pleuritic CP, productive cough
  • Fever is seen in 80%
• Tachypnea
  • Most sensitive sign in elderly

Work-Up

1. CXR
2. CBC
3. Chemistry

If pt to be admitted:

1. Blood cultures (required if pt may require ICU during their course)
2. Sputum staining
   1. If concern for particular organism

Treatment

• Abx within 6 hours
  • 10-14 days

Outpatient

1. Healthly
   1. Macrolide OR doxycycline
2. Unhealthy
   1. Respiratory fluoroquinolone alone OR macrolide + beta-lactam

Inpatient

1. Ward
   1. Respiratory fluoroquinolone alone OR macrolide + beta-lactam
2. ICU, low risk of pseudomonas
   1. Beta-lactam + (macrolide OR respiratory fluoroquinolone)
3. ICU, risk of pseudomonas
   1. Cefipime, imipenem, OR piperacillin-tazobactam + IV cipro/levo
   2. Cefipime, imipenem, OR piperacillin-tazobactam + gent + azithromycin
   3. Cefipime, imipenem, OR piperacillin-tazobactam + gent + cipro/levo

Pseudomonas risk factors

1. Alcoholism
2. Immunosuppression (incl. steroids)
3. Structural lung disease
4. Malnutrition
5. Recent abx
6. Recent hospital stay

Disposition

See Pneumonia (Port Score)

See Also

Pneumonia (Pathogens)

Pneumonia (Peds)

Pneumonia (Port Score)

Source

UpToDate