FortifyMDPneumonia
An acute lower respiratory tract infection associated with fever, symptoms and signs in the chest, and abnormalities on the chest x-ray
Investigations
CXROxygen saturationABGif SaO2 <92% or severe pneumonia.CBCUrea&CreatinineElectrolytesLiver Function TestCRPBlood cultures(if CURB-65 ≥2).Sputum cultures(if CURB-65 ≥3 or if CURB-65 =2 and not had antibiotics yet).- Urine pneumococcal antigen (if CURB-65 ≥2)
- Legionella antigen (if CURB-65 ≥3 or if clinical suspicion).
- Consider need for viral throat swabs and mycoplasma PCR/serology.
- Pleural fluid may be aspirated for culture (if CURB-65 ≥2).
- Consider bronchoscopy and bronchoalveolar lavage if the patient is immunocompromised or on ICU.
Treatment
- Oral antibiotic: If not severe and not vomiting (CURB-65 1–2)
- IV antibiotics: if severe (CURB-65 >2).
Oxygen: keep PaO2 >8.0 and/or saturation ≥94%.IV fluidsVTE prophylaxis.Analgesiaif pleurisy.- Consider ICU if shock, hypercapnia, or remains hypoxic.
- Follow-up: at 6 weeks (±CXR).
Community-acquired
| Severity | Organisms | Antibiotics |
|---|---|---|
| Mild not previously treated CURB 0–1 | Streptococcus pneumoniae Haemophilus influenzae | Oral amoxicillin 500mg–1g/8h or clarithromycin 500mg/12h or doxycycline 200mg loading then 100mg/day (initially 5-day course) |
| Moderate CURB 2 | Streptococcus pneumoniae Haemophilus influenzae Mycoplasma pneumoniae | Oral amoxicillin 500mg–1g/8h + clarithromycin 500mg/12h or doxycycline 200mg loading then 100mg/12hIf IV required: amoxicillin 500mg/8h +clarithromycin 500mg/12h (7-day course) |
| Severe CURB >3 | As above | Co-amoxiclav 1.2g/8h IV or cephalosporin IV(eg cefuroxime 1.5g/8h IV) AND clarithromycin 500mg/12h IV (7 days) |
| Panton-Valentine Leukocidin-producing Staph. aureus (PVL-SA) | Seek urgent help. Consider adding IV linezolid, clindamycin, and rifampicin | |
| Atypical | Legionella pneumophilia | Fluoroquinolone combined with clarithromycin, or rifampicin, if severe. |
| Chlamydophila species | Tetracycline | |
| Pneumocystis jirovecii | High-dose co-trimoxazole |
Hospital-acquired
| Organisms | Antibiotics |
|---|---|
| Gram-negative bacilli Pseudomonas Anaerobes | Aminoglycoside IV + antipseudomonal Aminoglycoside IV + antipseudomonal IV |
Aspiration
| Organisms | Antibiotics |
|---|---|
| Streptococcus pneumoniae Anaerobes | Cephalosporin IV + metronidazole IV |
Neutropenic patients
| Organisms | Antibiotics |
|---|---|
| Gram-positive cocci Gram-negative bacilli | Aminoglycoside IV + antipseudomonal penicillin IV or 3rd generation cephalosporin IV |
| Fungi | Antifungals |
Pheochromocytoma emergencies
Patients with pheochromocytoma may have had undiagnosed symptoms for some time, but stress, abdominal palpation, parturition, general anaesthetic, or contrast media used in imaging can cause acute hypertensive crises.
Pneumothorax
Mentions key items in pneumothorax management.