Cap by Drhafsah

Community Acquired Pneumonia (CAP) byDefinition OF PNEUMONIA
… an acute infection of the pulmonary parenchyma that is associated with symptoms of acute infection, accompanied by the presence of an acute infiltrate on a chest radiograph, or auscultatory findings consistent with pneumonia
NICE:
develops in a nursing home resident is included
diagnosis is Confirmed by chest X-ray.
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Good GC
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J Chr Dis 1984;37:215-25
About 2/3 of CAP are due to S.pneumoniae
These are gram positive diplococci
Lobar infiltrate on CXR
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Blood tinged sputum - Pneumococcal, Klebsiella, Legionella
H.influenzae CAP has associated of pleural effusion
S.Pneumoniae – commonest – penicillin resistance problem
S.aureus, K.pneumoniae, P.aeruginosa – not in typical host
S.aureus causes CAP in post-viral influenza; Serious CAP
K.pneumoniae primarily in patients of chronic alcoholism
P.Aeruginosa causes CAP in pts with CSLD or CF, Nosocom
Aspiration CAP only is caused by multiple pathogens
Extra pulmonary manifestations only in Atypical CAP
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Pathogen directed antimicrobial therapy whenever possible
Prompt initiation of Antibiotic therapy
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Severity assessment in primary care
When a clinical diagnosis of community-acquired pneumonia is made in primary care, determine whether patients are at low, intermediate or high risk of death using the CRB65 score
CRB65 score for mortality risk assessment in primary care[a]
calculated by giving 1 point for each of the following prognostic features:
1. confusion (abbreviated Mental Test score 8 or less, or new disorientation in
person, place or time)[b]
2. raised respiratory rate (30 breaths per minute or more)
3. low blood pressure (diastolic 60 mmHg or less, or systolic less than 90 mmHg)
4. age 65 years or more.
Patients are stratified for risk of death as follows:
0: low risk (less than 1% mortality risk)
1 or 2: intermediate risk (1-10% mortality risk)
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Use clinical judgement in conjunction with the CRB65 score to inform decisions about whether patients need hospital assessment as follows:
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0 or 1: low risk (less than 3% mortality risk)
2: intermediate risk (3-15% mortality risk)
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Antibiotic therapy
Low-severity CAP
Offer a 5-day course of a single antibiotic to patients with low-severity CAP
Consider amoxicillin in preference to a macrolide or a tetracycline for patients with low-severity community-acquired pneumonia. Consider a macrolide or a tetracycline for patients who are allergic to penicillin.
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2. Moderate- and high-severity CAP
**. 7- to 10-day course of antibiotic therapy for patients with moderate or high-severity CAP
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