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Pneumonia

Pneumonia ()

- alveoli Bronchiole
- , ,
- 2 CAP Nosocomial

0-1

OPD

IPD

3-5

ICU

CAP (community-acquired pneumonia)

- . ( D/C
3 wks, immune )
Nosocomial
HAP (hospital-acquired pneumonia)

- . > 48 .
VAP (ventilation-acquired pneumonia)
- 48 .
48 .
HCAP (Healthcare-acquired pneumonia)

- . > 48 . 90 D/C
- Nursing home, long-term care facility
- IV, hemodialysis unit
CAP
: (pulmonary infiltration), 3/5
(), ( 2wk.),

(CURB-65)
**** 1 point****
C: confusion
U: BUN > 17 mmol/L > 20mg/dl
R: RR > 30
B: BP SBP< 90 mmHg DBP < 60 mmHg
65: Age > 65

: OPD = 1-3, IPD = 1-5, ICU = 1-6


1= Streptococcus pneumoniae
2= Atypical pathogen (Chlamydia pneumoniae,
Mycoplasma pneumoniae, Legionella spp.)
3 = Respiratory viruses,
4 = Staphylococcus. aureus
5 = (-) ve enteric bacteria,
6 = Pseudomonas aeruginosa
CAP:
> Empiric >
Empiric therapy
OPD case

- 3
Macrolides, Doxycycline

- ( ),
3 Respiratory FQ
(Levofloxacin, Moxifloxacin, Gemifloxacin)
-lactam+Macrolides
IPD case

- non-ICU Respiratory FQ (Levofloxacin,


Moxifloxacin, Gemifloxacin) lactam+Macrolide

- ICU -lactam + Azithromycin -lactam


+ Respiratory FQ
-lactam Respiratory FQ + Aztreonam

P. Aeruginosa

- Antipneumo, AntiPseudo -lactam (Pip-Tazo,


cefepime, imipenem, meropenem) +
ciprofloxacin levofloxacin (750 mg)

- Antipneumo, AntiPseudo -lactam


+Aminoglycosides + Azithromycin
- Antipneumo ,AntiPseudo -lactam +
Aminoglycosides + Antipneumo FQ
(=Respiratory FQ)
CA-MRSA!! Vancomycin linezolid

HAP VAP
Onset Early onset late onset
: infiltrate 2/3
, WBC > 12,000
< 4,000 cell/mm3 CPIS (
criteria )
HAP/VAP
early late
Early

Late

within 5 days

5 days or more

S. pneumoniae
H.influenzae
MSSA
susceptible (-) ve bacteria

P. aeruginosa
Acinetobacter spp.
MRSA
multi resistant organism

Empiric therapy
Early onset : ceftriaxone FQs
levofloxacin, moxifloxacin, ciprofloxacin
Ampicillin/sulbactam Ertapenem

Late onset :
MRSA linezolid vancomycin
P.aeruginosa, Acinetobacter species., K.
pneumoniae ncombination therapy
Antipseudomonal cephalosporins (ceftazidime,
cefepime) Antipseudomonal carbapenem
(imipenem, meropenem) -lactam/-lactamase
inhibitors (Pip-tazo) Antipseudomonal
fluoroquinolone (ciprofloxacin, levofloxacin)
aminoglycosides (amikacin, gentamicin,
tobramycin)
Virus (Influenza A H1N1)
Antiviral:
- Oseltamivir 75mg bid 5-10
(CrCl 10-30 ml/min) 75 mg OD
zanamivir 10 mg bid
()
- Oseltamivir 3mg/kg bid zanamivir
5
Antibacterials: pneumonia 5-7
Systemic corticosteroids: severe pneumonia
Bronchodilators: rhonchi

S. pneumonia
L. pneumophila anorexia
N/V/D

M. pneumoniae
N/V/D
hemolytic anemia, meningoencephalitis
Chlamydophila pneumonia
mild respiratory symptoms