COMMUNITY ACQUIRED PNEUMONIA ASSIGNMENT HELP

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Community-Acquired Pneumonia

Meaning of Community-Acquired Pneumonia:

Community-acquired pneumonia is one of the most common diseases that is infectious and is addressed by clinicians. It is one of the major health problems that exist in the country of United States. Further, it is the most important cause of mortality and morbidity worldwide.

Community-acquired pneumonia is a disease acquired from outside the hospital or long-term facility. It takes its toll within 48 hours of hospital admission or in a patient who presents pneumonia but does not have any of the characteristics of the healthcare-associated pneumonia.

Pathogens responsible for the disease:

There are a number of pathogens that give rise to such a disease. The following is the list of the pathogens:

  1. Streptococcus pneumonia: this is penicillin-sensitive and resistant strains
  2. Haemophilus influenza: this is an ampicillin-sensitive and resistant strain
  3. Moraxella catarrhalis: this is all strains penicillin-resistant

Moraxella catarrhalis causes 85% of community-acquired pneumonia cases.

CAP is acquired when any person inhales or aspires to any pulmonary pathogen into the segment of the lung or the lobe. (Emedicine.medscape.com, 2014)

Symptoms of CAP:

A typical CAP is often subacute. A normal and a usual CAP includes the following symptoms:

  1. Psittacosis
  2. Q fever
  • Tularemia
  1. Mycoplasma pneumonia
  2. Legionnaires disease
  3. Chlamydophila (Chlamydia) pneumonia

Extrapulmonary signs and symptoms seen in some forms of atypical CAP may include the following:

  1. Mental confusion
  2. Prominent headache
  • Myalgias
  1. Ear pain
  2. Abdominal pain
  3. Diarrhea
  • Rash (Horder spots in psittacosis; erythema multiform in mycoplasma pneumonia)
  • Nonexudative pharyngitis
  1. Hemoptysis
  2. Splenomegaly
  3. Relative bradycardia

(Emedicine.medscape.com, 2014)

Treatment of CAP:

  1. Azithromycin500 mg PO one dose, then 250 mg PO daily for 4 d or extended-release 2 g PO as a single dose
  2. Clarithromycin500 mg PO bid or extended-release 1000 mg PO q24hor
  3. Doxycycline100 mg PO bid

In case it is received prior to the antibiotic within the duration of 3 months:

  1. Azithromycin or clarithromycin plus amoxicillin1 g PO q8h or amoxicillin-clavulanate 2 g PO q12h
  2. A respiratory fluoroquinolone (eg, levofloxacin 750 mg PO daily or moxifloxacin 400 mg PO daily)

In case, Comorbidities are present, for example, alcoholism, bronchiectasis/cystic fibrosis, COPD, IV drug user, post influenza, asplenia, diabetes mellitus, lung/liver/renal diseases), then the following medicine is prescribed:

  1. Levofloxacin750 mg PO q24h or
  2. Moxifloxacin400 mg PO q24h or
  3. Combination of a beta-lactam (amoxicillin1 g PO q8h or amoxicillin-clavulanate 2 g PO q12hor ceftriaxone 1g IV/IM q24h or cefuroxime 500 mg PO BID) plus  a macrolide (azithromycin or clarithromycin)

The duration of the treatment is at least 5 days. The patient should be afebrile for 48 to 72 hours or until afebrile for 3 days. If the initial therapy was not active, a longer duration of treatment would be required. Further, prolonged treatment would be required if the disease is complicated by extrapulmonary infection.

The following is the treatment for non-ICU patients:

  1. Levofloxacin 750 mg IV or PO q24h
  2. Moxifloxacin 400 mg IV or PO q24h or
  3. Combination of a beta-lactam (ceftriaxone 1 g IV q24h or cefotaxime1 g IV q8h or ertapenem 1 g IV daily or ceftaroline 600 mg IV q12h) plus azithromycin 500 mg IV q24h

The duration of the therapy is at least 5 days. The patient must be afebrile for about 48 to 72 hours, have stable blood pressure, adequate oral liquid intake, and have room oxygen saturated to greater than 90%. However, room oxygen may be required for a longer duration in some cases.

The following is the treatment for Severe COPD:

  • Levofloxacin 750 mg IV or PO q24h or
  • Moxifloxacin 400 mg IV or PO q24h or
  • Ceftriaxone 1 g IV q24h or ertapenem1 g IV q24h plus azithromycin 500 mg IV q24h

In case, the gram-negative rod pneumonia is suspected due to alcoholism with necrotizing pneumonia, chronic bronchiectasis/tracheobronchitis due to cystic fibrosis, mechanical ventilation, febrile neutropenia with pulmonary infiltrate, septic shock with organ failure, then the following treatment is suggested:

  • Piperacillin-tazobactam5 g IV q6h or 3.375 g IV q4h or  4-h infusion of 3.375 g q8h or
  • Cefepime2 g IV q12h or
  • Imipenem/cilastatin 500 mg IV q6h or meropenem1 g IV q8h or
  • If penicillin is allergic, substitute aztreonam 2 g IV q6h plus
  • Levofloxacin 750 mg IV q24h or
  • Moxifloxacin 400 mg IV or PO q24h or
  • Aminoglycoside (gentamicin7 mg/kg/day IV or tobramycin 7 mg/kg/day IV )
  • Add azithromycin 500 mg IV q24h if respiratory fluoroquinolone not used

The duration of the therapy is 10 to 14 days.

In the case of concomitant with or post influenza:

  • Vancomycin 15 mg/kg IV q12h or  linezolid 600 mg IV bid plus
  • Levofloxacin 750 mg IV q24h or
  • Moxifloxacin 400 mg IV or PO q24h

If received a prior antibiotic within 3 months:

  • High-dose ampicillin 2 g IV q6h (or penicillin G, if not resistant); if penicillin-allergic, substitute with vancomycin 1 g IV q12h plus
  • Azithromycin 500 mg IV q24h plus
  • Levofloxacin 750 mg IV q24h or moxifloxacin 400 mg IV/PO q24h

In the case of risk of aspiration pneumonia/anaerobic lung infection/lung abscess, then the following treatment is suggested:

  • Clindamycin 300-450 mg PO q8h or
  • Ampicillin-sulbactam 3 g IV q6h or
  • Ertapenem 1 g IV q24h or
  • Ceftriaxone 1 g IV q24h plus  metronidazole 500 mg IV q6h or
  • Moxifloxacin 400 mg IV or PO q24h or
  • Piperacillin-tazobactam 3.375 g IV q6h or
  • If methicillin-resistant S aureus (MRSA) is suspected, add vancomycin15 mg/kg IV q12h or linezolid 600 mg IV/PO q12h
  • If influenza is suspected, add oseltamivir75 mg IV or PO q12h for 5 d

(Mayoclinic.org, 2014)

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