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Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Typically symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing. Severity is variable. Pneumonia is usually caused by infection with viruses or bacteria and less commonly by other microorganisms, certain medications and conditions such as autoimmune diseases. Risk factors include cystic fibrosis, chronic obstructive pulmonary disease (COPD), asthma, diabetes, heart failure, a history of smoking, a poor ability to cough such as following a stroke, and a weak immune system. Diagnosis is often based on the symptoms and physical examination. Chest X-ray, blood tests, and culture of the sputum may help confirm the diagnosis. The disease may be classified by where it was acquired with community, hospital, or health care associated pneumonia. Vaccines to prevent certain types of pneumonia are available. Other methods of prevention include handwashing and not smoking. Treatment depends on the underlying cause. Pneumonia believed to be due to bacteria is treated with antibiotics. If the pneumonia is severe, the affected person is generally hospitalized. Oxygen therapy may be used if oxygen levels are low. Pneumonia affects approximately 450 million people globally (7% of the population) and results in about four million deaths per year. Pneumonia was regarded by William Osler in the 19th century as "the captain of the men of death". With the introduction of antibiotics and vaccines in the 20th century, survival improved. Nevertheless, in developing countries, and among the very old, the very young, and the chronically ill, pneumonia remains a leading cause of death. Pneumonia often shortens suffering among those already close to death and has thus been called "the old man's friend"
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Newly Approved Agents: Lefamulin, the first systemic pleuromutilin antibiotic, was approved by the FDA in August 2019 (after the societies’ approval of the guidelines) for the treatment of adults with CAP caused by S pneumoniae, methicillin-susceptible S aureus (MSSA), H influenzae, Legionella pneumophila, M pneumoniae, and C pneumoniae.11,12 Lefamulin acts as a bacterial protein synthesis inhibitor by targeting the peptidyl transferase center of the 50S bacterial ribosomal subunit. It may be given either IV or orally at a dosage of 150 mg IV every 12 hours or 600 mg orally every 12 hours, with dosage adjustment required for patients with hepatic impairment. Lefamulin may prolong the QT interval, and its use should be avoided in patients who have known QT prolongation or are taking other QT-prolonging agents. Lefamulin has several other drug interactions. Its use should be avoided (because of potential for reduced efficacy) with strong or moderate CYP3A inducers or P-glycoprotein (Pgp) inducers. The oral formulation of lefamulin should not be used with agents that are that are strong CYP3A inhibitors or Pgp inhibitors or with CYP3A4 substrates that prolong the QT interval. Lefamulin may cause fetal harm, and females should be counseled to use effective contraception during treatment and for 2 days after completion of therapy.11-13 Delafloxacin, a fluoroquinolone antibiotic, was approved in October 2019 (after the guidelines were published) for treatment of adults with CAP caused by S pneumoniae, MSSA, selected gram-negative pathogens (Klebsiella pneumoniae, Escherichia coli, P aeruginosa, H influenzae, Haemophilus parainfluenzae), and atypical microorganisms (C pneumoniae, L pneumophila, M pneumoniae).14 It may be given either IV or orally at a dosage of 300 mg IV every 12 hours or 450 mg orally every 12 hours, with adjustment required for patients with severe renal impairment. Delafloxacin has the same warnings and precautions as other agents in the fluoroquinolone antimicrobial class.14,15 Directed Treatment The patient’s clinical response should be evaluated after initiation of antimicrobial therapy. In cases where blood and/or sputum cultures are recommended, once microbiology culture and sensitivity results are available, antibiotic coverage should be deescalated and therapy should be directed at the pathogen(s) causing disease.4,9 Duration of Therapy The recommended duration of antibiotic therapy has not changed from previously published guidelines. Patients with CAP should be treated for a minimum of 5 days, with antibiotic therapy continued until the patient achieves clinical stability. Validated measures of clinical stability include resolution of vital sign abnormalities (heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature); ability to eat; and normal mental status. Given that most patients achieve clinical stability within 48 to 72 hours after therapy initiation, a 5-day course typically is sufficient
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Pneumonia
1.
PNEUMONIA Dr. Nooruddin
Jaffer Professor of Medicine.
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Four patient categories
have been defined on the basis of information collected at the time of initial evaluation
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DIAGNOSIS
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DIAGNOSIS Sputum Gram
Stain
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Complications of Pneumonia
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COMPLICATIONS
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