PCAP

WHO SHALL BE CONSIDERED AS HAVING COMMUNITY-ACQUIRED PNEUMONIA?

 presenting with cough and/or respiratory difficulty may be evaluated for possible
presence of pneumonia
 ER
1. O2 sat < 94% at room air in 3 mo to 5 years, and >5 years old without any
comorbid conditions affecting oxygenation
2. Tachypnea
3. Chest wall retractions
4. Fever, grunting, wheezing, decreased breath sounds, nasal flaring, cyanosis,
crackles or localized chest findings at any age
5. Consolidation in ultrasound
 Chest x-ray may be requested
1. Dehydration in a patient aged 3 months to 5 years
2. High index of clinical suspicion

WHO SHALL BE CONSIDERED AS HAVING COMMUNITY-ACQUIRED PNEUMONIA?

1. classified as pCAP A, B, C or D within 48 hours after consultation

2. patient initially pCAP A or B but not responding to current treatment after 48 hours maybe admitted
3. patient classified as pCAP C may be
3.1. admitted to the regular ward
3.2. managed initially as outpatient if the ff are not present:
3.2.1. < 2 years old.
3.2.2. Convulsion
3.2.3. Chest x-ray with effusion, lung abscess, air leak or multilobar consolidation.
3.2.4. Oxygen saturation < 95% at room air.
4. A patient classified as pCAP D may be admitted to a critical care unit
WHAT DIAGNOSTIC AIDS ARE INITIALLY REQUESTED FOR A PATIENT CLASSIFIED AS EITHER pCAP A or
pCAP B BEING MANAGED IN AN AMBULATORY SETTING?

1. The following may be requested at initial site-of-care

 assessment of gas exchange
i. Oxygen saturation using pulse oximetry
 microbial determination of underlying etiology
i. Gram stain and/or aerobic culture and sensitivity of sputum
 clinical suspicion of necrotizing pneumonia, multilobar consolidation, lung abscess, pleural effusion,
pneumothorax or pneumomediastinum
i. Chest x-ray PA-lateral
ii. Chest ultrasound
2. The following may not be requested.
 microbial determination of underlying etiology
i. Blood culture and sensitivity
 basis for initiating antibiotic treatment
i. White blood cell [WBC] count
ii. C-reactive protein [CRP]
iii. Procalcitonin [PCT)

WHAT DIAGNOSTIC AIDS ARE INITIALLY REQUESTED FOR A PATIENT CLASSIFIED AS EITHER pCAP C or
pCAP D BEING MANAGED IN A HOSPITAL SETTING?

1. the following diagnostic aids may be requested at initial site-of-care.

 assessment of gas exchange
1.1. Oxygen saturation using pulse oximetr
1.2. Arterial blood gas
 Surrogate markers for possible presence of pathogens requiring initialempiric antibiotic with
microbiology as the reference standard
1.3. C-reactive protein [CRP]
1.4. Procalcitonin [PCT]
1.5. Chest x-ray PA-lateral
1.6. White blood cell [WBC]
 clinical suspicion of necrotizing pneumonia, multilobar consolidation, lung abscess, pleural effusion,
pneumothorax or pneumomediastinum.
1.7. Chest x-ray PA-lateral [Recommendation Grade C1]
1.8. Chest ultrasound [Recommendation Grade B2]
 determination of underlying microbial etiology
i. Gram stain and/or aerobic culture and sensitivity of sputum, nasopharyngeal aspirate
and/or pleural fluid, and/or blood for pCAP C with lung abscess, empyema or
pneumothorax
ii. Gram stain and/or aerobic culture and sensitivity of sputum, tracheal aspirate and/or
pleural fluid, for pCAP D
iii. Anaerobic culture and sensitivity of sputum, nasopharyngeal aspirate, pleural fluid,
and/or blood culture and sensitivity for
1. pCAP C with lung abscess, empyema or pneumothorax
2. pCAP D
iv. Serum IgM for Mycoplasma pneumoniae
 DIAGNOSTICS pCAP A pCAP B pCAP C pCAP D
1. assessment of gas exchange - Oxygen saturation using pulse oximetry
- ABG
2. microbial determination of - Gram stain and/or aerobic - Gram stain and/or - Gram stain and/or
underlying etiology culture and sensitivity of aerobic culture and aerobic culture and
sputum sensitivity of sputum, sensitivity of sputum,
nasopharyngeal tracheal aspirate
may not be requested aspirate and/or and/or pleural fluid,
- Blood culture and pleural fluid, and/or for pCAP D
sensitivity blood for pCAP C
with lung abscess,
empyema or
pneumothorax

- Anaerobic culture
and sensitivity of - Anaerobic culture
sputum, and sensitivity of
nasopharyngeal sputum,
aspirate, pleural nasopharyngeal
fluid, and/or blood aspirate, pleural
culture and fluid, and/or blood
sensitivity for pCAP culture and
C with lung abscess, sensitivity for pCAP
empyema or D
pneumothorax
- Serum IgM for Mycoplasma pneumoniae
3. clinical suspicion of necrotizing - Chest x-ray PA-lateral
pneumonia, multilobar consolidation, - Chest ultrasound
lung abscess, pleural effusion,
pneumothorax or
pneumomediastinum.
4. Surrogate markers for possible - CRP
presence of pathogens requiring may not be requested - PCT
initial empiric antibiotic with - CRP - Chest x-ray PA-lateral
microbiology as the reference - PCT - [WBC]
standard - WBC

5. determination of metabolic - pH in arterial blood gas for metabolic acidosis

derangement for immediate - Serum sodium for hyponatremia
correction - Serum potassium for hypokalemia

WHEN IS ANTIBIOTIC RECOMMENDED?

1. For pCAP C, empiric antibiotic may be started if any of the following is present.
a. Elevated serum C-reactive protein [CRP] [
b. serum procalcitonin level [PCT]
c. white blood cell [WBC] count greater than 15,000
d. lipocalin 2 [Lpc-2]
e. Alveolar consolidation on chest x-ray
f. Persistent high-grade fever without wheeze
2. For pCAP D, a specialist may be consulted
WHAT EMPIRIC TREATMENT SHOULD BE ADMINISTERED IF A BACTERIAL
ETIOLOGY IS STRONGLY CONSIDERED?

WHAT TREATMENT SHOULD BE INITIALLY GIVEN IF A VIRAL ETIOLOGY IS

STRONGLY CONSIDERED?

WHEN CAN A PATIENT BE CONSIDERED AS RESPONDING TO CURRENT

THERAPEUTIC MANAGEMENT?

WHAT SHOULD BE DONE IF A PATIENT IS NOT RESPONDING TO CURRENT

THERAPEUTIC INTERVENTION?

WHEN CAN SWITCH THERAPY IN BACTERIAL PNEUMONIA BE STARTED?

WHAT ANCILLARY TREATMENT CAN BE GIVEN?

HOW CAN PNEUMONIA BE PREVENTED?