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Pneumonia

Pneumonia. The types. Community acquired acute Community acquired atypical Hospital acquired Aspiration Chronic Necrotising and lung abscess In the immuno -compromised host. Community acquired acute. Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis

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Pneumonia

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  1. Pneumonia

  2. The types • Community acquired acute • Community acquired atypical • Hospital acquired • Aspiration • Chronic • Necrotising and lung abscess • In the immuno-compromised host

  3. Community acquired acute • Streptococcus pneumoniae • Haemophilusinfluenzae • Moraxella catarrhalis • Staphylococcus aureus • Legionella pneumophila • Klebsiellapneumoniae Gram +vecocci Gram –ve pleomorphic rods Gram -vecocci Gram +vecocci Gram –ve rod-like Gram -ve rods

  4. Community acquired atypical • Mycoplasma pneumoniae • Chlamydia spp (pneumoniae, psittaci, trachomatis) • Coxiellaburnetii (Q fever) • Viruses • RSV • parainfluenza virus (children) • Influenza A and B (adults) • Adenovirus • SARS pleiomorphic Obligate intracellular Obligate intracellular

  5. Hospital acquired • Gram –ve rods, Enterobacteriaceae • Klebsiellaspp • Serratiamarcescens • E. coli • Pseudomonas aeruginosa • Staphylococcus aureus (MRSA) Gram –ve rods Gram –ve rod Gram +vecocci

  6. Aspiration • Anaerobic oral flora • Bacteroides, Prevotella, Fusobacterium • Aerobic bacteria • Strep pneumoniae, Staph aureus, Haeminfluenzae, pseudomonas aeruginosa • Pneumonia may be due to chemical damage (gastric acid) and partly bacterial (from flora) • Possible lung abscess formation

  7. Chronic • Nocardia (oral commensal, also in some soil) • Actinomyces (oral, opportunistic) • Granulomatous • Mycobacterium tuberculosis (bacteria) • Histoplasmacapsulatum (fungi) • Coccidioidesimmitis (fungi) • Blastomycesdermatitidis (fungi)

  8. Necrotising and lung abscess • Anaerobic bacteria with or without mixed aerobic infection • Staph aureus • Klebsiellapneumoniae • Strep pyogenes

  9. In the immuno-compromised host • Cytomegalovirus • Pneumocystis jiroveci • Mycobacterium avium-intracellulare • Invasive aspergillosis • Invasive candidiasis • All usual bacteria and viruses previously mentioned

  10. Treatment • Pneumococcal pneumonia • benzylpenicillin 1.2 g (child: 30 mg/kg up to 1.2 g) IV, 6-hourly until significant improvement • then amoxycillin 1 g (child: 25 mg/kg up to 1 g) orally, 8-hourly for a total duration of 7 days. In some cases, oral amoxycillin alone (without IV benzylpenicillin) may be sufficient.

  11. Treatment • Staphylococcal pneumonia • Non-MRSA • di/flucloxacillin 2 g (child: 50 mg/kg up to 2 g) IV, 4- to 6-hourly • Penicillin allergy • cefalotin 2 g (child: 50 mg/kg up to 2 g) IV, 4-hourly • OR • cephazolin 2 g (child: 50 mg/kg up to 2 g) IV, 8-hourly. • MRSA • vancomycin as above. In severe cases, additional antibiotics (eg clindamycin, linezolid, or the combination of rifampicin and fusidate sodium, depending on susceptibility results) may be warranted

  12. Treatment • Legionella pneumonia • Mild • azithromycin 500 mg orally, daily for 5 days • OR • doxycycline 100 mg orally, 12-hourly for 10 to 14 days. • Severe • azithromycin 500 mg IV or orally, daily • PLUS EITHER • ciprofloxacin 400 mg IV, 12-hourly or ciprofloxacin 750 mg orally, 12-hourly • OR • rifampicin 300 mg IV or orally, 12-hourly

  13. Pop Quiz • Name 2 bacteria mentioned as causing acute community acquired pneumonia: • Answer • Streptococcus pneumoniae • Haemophilusinfluenzae • Moraxella catarrhalis • Staphylococcus aureus • Legionella pneumophila • Klebsiellapneumoniae

  14. Pop Quiz • True/False: Chronic pneumonia is caused by viruses, bacteria and fungi? • Answer • False (only fungi and bacteria cause chronic pneumonia)

  15. Pop Quiz • Jimmy’s culture results indicate a staphylococcal pneumonia, which treatment would you recommend? • A) cefalotin 2 g IV, 4-hourly or cephazolin 2 g IV, 8-hourly • B) di/flucloxacillin 2 g IV, 4- to 6-hourly • C) Vancomycin 2 g IV, 4- to 6-hourly • Answer: B

  16. Pop Quiz • As you are about write the order, Jimmy mentions that he had some reaction to a pretty common antibiotic when he was a kid. Does this change your treatment decision, and if so, what would you be recommending? • Answer • Due to the chance that this drug hypersensitivity reaction may have been due to Penicillin use, it may be safer to order: cefalotin 2 g IV, 4-hourly or cephazolin 2 g IV, 8-hourly

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