Tips for the inpatient management of community acquired pneumonia
How do I know if my patient needs ICU admission?
- The best scoring system is the Pneumonia Severity Index (PSI) for deciding on ICU admission and inpatient treatment. You can also use the CURB-65 score or the SMART-COP score but these are less sensitive.
- In general, PSI score of 4 or 5 tends to require ICU admission
Do I still need to treat within 4 hours?
- No, not really. Just try to do it as fast as you reasonably can do without over-treating
What do I use for general inpatient treatment?
- Beta-lactam plus a macrolide or a quinolone alone. These work pretty well, cure rate around 90% or so
What about ICU admission treatment?
- You can stick with a beta-lactam plus a macrolide or quinolone in some cases but should be aware of certain issues
- Consider influenza now that we have entered the flu season
- Consider Staph aureus coverage for patients with influenza or those on chronic glucosteroids. Use linezolid or vancomycin for this.
- Consider P. aeruginosa coverage in patients with COPD or bronchiectasis.
How long do I treat for?
- This can vary based on clinician preference but there is good data to support treating for around 5-7 days
- Longer treatment for Staph aureus or gram negative bacilli.
What if there is no response?
- Consider correct dosage of medications, possible antibiotic resistance, empyema, noninfectious cause etc.
References
Community-Acquired Pneumonia
Daniel M. Musher, M.D., and Anna R. Thorner, M.D.
N Engl J Med 2014; 371:1619-1628October 23, 2014DOI: 10.1056/NEJMra1312885