Community Acquired Pneumonia
Infection Community acquired pneumonia Brief outline/clinical setting Criteria for CAP: A new pulmonary infiltrate (within 24 h of admission) associated with at least one of the following: 1. A new or increased cough with/without sputum production 2. Fever (>37.8° C ) or hypothermia (<35.6° C), 3. Leukocytosis, a left shift, or leukopenia based on local normal values. Provided there was no
| Infection | Community acquired pneumonia |
| Brief outline/clinical setting |
Criteria for CAP: A new pulmonary infiltrate (within 24 h of admission) associated with at least one of the following: 1. A new or increased cough with/without sputum production |
| Aetiologies/organisms | Streptococcus pneumonia is the commonest bacterial pathogen. Other pathogens Staphylococcus aureus, Gram negatives, such as Pseudomonas aeruginosa, Klebsiella Pneumonia These are more common in patients with co-morbid disease, especially structural lung disease or on corticosteroids Polymicrobial infections are common (bacterial and viral pathogens) Atypical bacterial organisms (Legionella, Chlamydia and Mycoplasma) are uncommon but there may have cyclical increases Consider Mycobacteria Tuberculosis infection Consider Pneumocystis jirovecii infection in HIV positive patients |
| Optimal antimicrobial selection | Outpatient: Amoxicillin 1g tds PO or Amoxicillin- clavulanate 1g tds PO Inpatient: - Amoxicillin- clavulanate 1,2g tds IVI - Cefuroxime 1.5g IVI tds Inpatients (SEVERE) CURB ≥3: Ceftriaxone 1g IVI BD Inpatients (Severe)CURB ≥ 3 ADD Azithromycin 500mg IVI/PO daily x 3 days (Immunomodulation and legionella cover) |
| Duration | 5 days Switch from ivi to oral when: - Hemodynamically stable (heart rate <100) - Respiratory rate< 25 - Oxygen sats >92% off oxygen - Temperature <37.8 - Free of delirium - Able to take orally |
| Alternative if allergic/not available | Ceftriaxone 1g IVI BD – limited cross reactivity amongst penicillin allergic patients |
| Rationale | |
| Level of evidence | High |
| Link to Guideline | Click here |