Pneumonia

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Pneumonia is acute respiration infection that causes inflammation of the tissue in one or both lungs.  The alveoli of the lungs are filled with pus and fluid, making breathing painful and limiting oxygen intake. Pneumonia accounts for 15% of all deaths of children under 5 years old. Predisposing factors include malnutrition, old age, immunosuppression, cardiovascular diseases, diabetes.

Causes

Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. The most common are:

  • Bacterial pneumonia
    • Streptococcus pneumoniae 
  • Viral pneumonia 
    • Respiratory syncytial virus (RSV)
    • Haemophilus influenzae type b (Hib)
  • Aspiration pneumonia – caused by aspirating vomit, smoke, or any substance
  • Fungal pneumonia – Affect people with immunosuppression
    • Mycoplasma pneumoniae
  • Hospital-acquired pneumonia
    • Pseudomonas aeruginosa

Signs and symptoms

  • Breathing is rapid, shallow and difficult
  • Fever
  • Cough may be dry, or produce thick yellow, green, brown or blood-stained phlegm
  • Chest pain

Differential diagnosis

  • COPD 
  • Asthma
  • Pulmonary oedema
  • Pulmonary embolism

Complications

  • Bacteraemia and septic shock
  • Lung abscesses. 
  • Pleural effusions, empyema, and pleurisy
  • Respiratory failure

Investigations

  • Chest x ray 
  • Blood cultures

Treatment objectives

  • Restore respiratory functions
  • Eradicate causative agents

Non-pharmacological treatment

  • Rest
  • Adequate hydration

Pharmacological treatment

Amoxicillin + clavulanic acid oral

Adults:

Amoxicillin 500mg + clavulanic acid 125 orally every 8 hours for 14 days.

Child:

Amoxicillin 15mg/kg + clavulanic acid (maximum 500mg) orally every 8 hours for 14 days.

 

OR

Ceftriaxone IV or IM

Adult

1 to 2 g IV or IM divided every 12 to 24 hours (Max: 4 g/day) depending on severity of illness and causative organism

Child:

50 to 75 mg/kg/dose IV or IM every 24 hours (Max: 1 g/day).

OR

50 to 75 mg/kg/day IV or IM divided every 12 hours (Max: 2 g/day) for serious infections.

OR

Amoxicillin oral

Adult:

500 mg orally every 8 hours for 10-14 days

Child:

50 mg/kg in 2 or 3 divided doses for 10-14 days

 

If received antibiotics within the past 3 months or with comorbidities

ADD

Azithromycin oral  

500 mg at once, then 250 mg daily

Note:

  • Administer for a minimum of 5 days
  • Should be afebrile for 48-72 hours
  • Or until afebrile for 3 days.

Prevention

  • Pneumococcal or influenza vaccination 
  • Stop smoking