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Plans for Diagnosis of Community Acquired Pneumonia

Plans for Diagnosis of Community Acquired Pneumonia. Diagnosis. Diagnosis is suspected on the basis of clinical presentation and is confirmed by chest x-ray. Diagnostic Plan. Chest x-ray almost always demonstrates some degree of infiltrate.

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Plans for Diagnosis of Community Acquired Pneumonia

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  1. Plans for Diagnosis of Community Acquired Pneumonia

  2. Diagnosis • Diagnosis is suspected on the basis of clinical presentation and is confirmed by chest x-ray

  3. Diagnostic Plan • Chest x-ray almost always demonstrates some degree of infiltrate. • In general, no specific findings distinguish one type of pneumonial infection from another, though: • multilobar infiltrates suggest S. pneumoniae or Legionellapneumophila infection • interstitial pneumonia suggests viral or mycoplasmal etiology.

  4. Diagnostic Plan • Hydrate patient • WBC count and electrolytes, BUN, and creatinine testing • to classify risk and hydration status • Blood cultures • to detect pneumococcal bacteremia and sepsis • Gram stain and culture of sputum • Sputum AFB smear to rule out active TB

  5. Philippine Community-Acquired Pneumonia (CAP) Guidelines 2004 CAP Any of the ff: Shock or signs of hypoperfusion, hypotension, altered mental state, urine output <30ml/hr PaO2 < 60mmHg or acute hypercapnea (PaCO2 > 50mmHg) at room air Any of the ff: RR ≥30/min PR ≥125/min Temp ≥40 or ≤35°C Suspected aspiration Extrapulmonary evidence of sepsis Unstable comorbid conditions CXR: multilobar, pleural effusion, abscess, progression of lesion to 75% in 24 hours High risk CAP YES YES ICU NO NO Low risk CAP Moderate risk CAP Out-patient In-patient

  6. Plans for Management of Community Acquired Pneumonia

  7. Management • Empirical antibiotic administration • Azithromycin 500 mg IV q 24 h plus β-lactam IV (cefotaxime 1 to 2 g q 8 to 12 h; ceftriaxone1 g q 24 h) • Macrolides • Antipneumococcalfluoroquinolonepoor IV • Improvement is manifested by decreased cough and dyspnea, defervescence, relief of chest pain, and decline in WBC count. • Failure to improve should rise suspicion of: • an unusual organism • Resistance to antibiotic • Empyema • coinfection or superinfection with a 2nd infectious agent

  8. Management • Supportive care: • Fluids • Antipyretics • Advise to refer back to DOTS with X-ray and sputum AFB results as outpatient

  9. MANAGEMENT OF CAP Fish D. Pneumonia. PSAP, Pharmacotherapy Self-Assessment Program. Kansas City, Mo.: American College of Clinical Pharmacy, 2002:202.

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