Management of pneumonia

MOHAMMAD BOSAEED
CONSULTANT INFECTIOUS DISEASES, KAMC-RD, MNGHA.
 Criteria for hospitalization

 Criteria for ICU admission

 Empiric antibiotic therapy

 Supportive therapy

 Prevention
Introduction
 pneumonia is a significant cause of morbidity and mortality in adults.

 Pneumonia is most commonly transmitted via airborne pathogens (primarily bacteria, but
also viruses and fungi) but may also result from the aspiration of stomach contents.  

 The most likely causal pathogens can be narrowed down based on patient age, immune
status, and where the infection was acquired (community-acquired or hospital-acquired). 

 Pneumonia is classified based on clinical features as either typical and atypical; each type
has its own spectrum of commonly associated pathogens. 
INPATIENT VS.
OUTPATIENT CARE

  CURB-65
 PSI
PSI
Criteria for ICU IDSA/ATS criteria for severe CAP 

 admission Major criteria •Septic shock/need for vasopressors

•Mechanical ventilation

Minor criteria
•Confusion
 based on clinical judgment. •Body temperature < 36°C
•Hypotension requiring fluid resuscitation
•Respiratory rate ≥ 30/min
•PaO2/FiO2 ≤ 250
•Leukopenia (WBC < 4,000/mm3) 
•Thrombocytopenia (platelet count < 100,000/mm3)
•BUN ≥ 20 mg/dL
•Multilobar infiltrates

Interpretation
•Severe CAP
•: one major criterion or ≥ 3 minor criteria
 Empiric antibiotic
therapy for
CAP
• 5 days of therapy is usually sufficient.

•  re-examined after 48–72 hours to evaluate the

efficacy of the prescribed antibiotic.

• Know the local resistance patterns 

 Empiric antibiotic
therapy for
CAP
Consider longer courses in patients with one of
the following:
•Patient not responding to treatment
•Suspected or concern for MRSA or P.
aeruginosa infection
•Concurrent meningitis
•Unusual pathogens (e.g., Burkholderia
pseudomallei, fungal infection)

Corticosteroids are not routinely recommended

Empiric Treatment Options for HAP
Risk Factors for
Multidrug-Resistant
Pathogens
 Resistance patterns can vary
widely; local antibiograms should
be considered when starting
empiric treatment .

 Empiric antibiotic therapy should

be narrowed and/or de-escalated as
soon as possible.
Supportive therapy

 Analgesia and antipyretics

 Chest physiotherapy

 Intravenous fluids (and, conversely, diuretics) if indicated

 Monitoring – Pulse oximetry with or without cardiac monitoring, as indicated

 Oxygen supplementation
 Positioning of the patient to minimize aspiration risk

 Respiratory therapy, including treatment with bronchodilators and, perhaps, N -

acetylcysteine in selected patients

 Suctioning and bronchial hygiene – Pulmonary toilet may include active suction of
secretions, chest physiotherapy, positioning to promote dependent drainage, and
incentive spirometry to enhance elimination of purulent sputum and to avoid
atelectasis.
Prevention

 Vaccination and others ..

Pneumococcal vaccine
 For immunocompetent adults aged  65 years and older ..
pneumococcal conjugate vaccine (PCV13) followed by pneumococcal polysaccharide vaccine
(PPSV23)

 in persons aged 2 years or older who are at high risk for pneumococcal disease because of
underlying medical conditions…
ACIP currently recommends that a dose of PCV13 be followed by a dose of PPSV23 

 Age 19–64 years with chronic medical conditions

 Age 19 years or older with immunocompromising conditions.
 Age 19 years or older with cerebrospinal fluid leak or cochlear implant
Influenza vaccine decreases fall and/or winter risk of viral
influenza, which decreases the risk of bacterial superinfection.

This vaccine is especially important in patients who are elderly

and in those with comorbid illnesses.

In fact, influenza vaccination for elderly individuals results in

a 48-57% reduction of the rate of hospitalization for
pneumonia and influenza
 smoking cessation to all patients but particularly those at risk of pneumonia and
influenza.

 Avoid contact with sick patients.

 Avoid unnecessary antibiotic use.

Prevention of nosocomial pneumonia

 Hand washing and isolation of patients with multiple resistant respiratory tract
pathogens.

  nutritional support

 attention to the size and nature of the gastrointestinal reservoir of microorganisms

 Careful handling of ventilator tubing and associated equipment

 subglottic secretion drainage, and lateral-rotation bed therapy

Thanks