UMEM Educational Pearls

Category: Critical Care

Title: Tips for the inpatient management of community acquired pneumonia

Keywords: cap, pneumonia, (PubMed Search)

Posted: 11/18/2014 by Feras Khan, MD (Updated: 4/24/2024)
Click here to contact Feras Khan, MD

Tips for the inpatient management of community acquired pneumonia

How do I know if my patient needs ICU admission?

The best scoring system is the Pneumonia Severity Index (PSI) for deciding on ICU admission and inpatient treatment. You can also use the CURB-65 score or the SMART-COP score but these are less sensitive.
In general, PSI score of 4 or 5 tends to require ICU admission

Do I still need to treat within 4 hours?

No, not really. Just try to do it as fast as you reasonably can do without over-treating

What do I use for general inpatient treatment?

Beta-lactam plus a macrolide or a quinolone alone. These work pretty well, cure rate around 90% or so

What about ICU admission treatment?

You can stick with a beta-lactam plus a macrolide or quinolone in some cases but should be aware of certain issues
Consider influenza now that we have entered the flu season
Consider Staph aureus coverage for patients with influenza or those on chronic glucosteroids. Use linezolid or vancomycin for this.
Consider P. aeruginosa coverage in patients with COPD or bronchiectasis.

How long do I treat for?

This can vary based on clinician preference but there is good data to support treating for around 5-7 days
Longer treatment for Staph aureus or gram negative bacilli.

What if there is no response?

Consider correct dosage of medications, possible antibiotic resistance, empyema, noninfectious cause etc.

Daniel M. Musher, M.D., and Anna R. Thorner, M.D.

N Engl J Med 2014; 371:1619-1628October 23, 2014DOI: 10.1056/NEJMra1312885