Pneumonia

In patient with Acute Cough, suspect pneumonia if:
  • fever + focal rales
  • fever + SOB [clear by history, or retractions on exam]
  • fever + pleuritic chest pain
  • fever + purulent sputum or hemoptysis which you see for yourself
  • fever + compromised host

CXR is very sensitive [rare false-negatives on Day #1].

Hospitalize Adults for Pneumonia if:
  • ? >65 yo; esp. >80 yo
  • O2 Sat <92%
  • Resp >28 / Pulse >120 / BP <90
  • Confusion
  • Comorbidities (renal insuff., liver failure, malignancy, etc)
If treating as an out-patient, must suspect a likely pathogen to treat empirically:
  • Pneumococcus is most common & most lethal.  Certainly suspect if CXR shows lobar consolidation (but can vary)
  • Consider Mycoplasma if young(ish) patient with bilateral interstitial infiltrates on CXR
  • Consider Staph [real bad] if IV drug use, or if pneumonia develops several days into Influenza.
Worry about drug-resistant Pneumococcus (? Rx levofloxacin) if:
  • Age >65 years
  • Antibiotics in past 3-6 mos.
  • Medical Co-Morbidities & Alcoholism
  • Exposure to a child in a day care center [?????]

See postings Acute Cough – 2 and Infectious Disease – 3.  Click for link to major professional organization Guidelines.

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