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Community Acquired Pneumonia in Adults
Community Acquired Pneumonia in Adults
CLINICAL
PRACTICE GUIDELINES
ON
COMMUNITY
ACQUIRED
PNEUMONIA IN
ADULTS
SANTISSIMA TRINIDAD HOSPITAL
PINAGBAKAHAN CITY OF MALOLOS, BULACAN
TEL (044) 791 -7331
Clinical Diagnosis
Cough, fever, difficulty of breathing, and/or chills within the past 24 hours to less than 2
weeks (A-II) associated with tachypnea (RR> 20 breaths/min), tachycardia (CR> 100/min),
and fever (T>37.8’c) with at least one abnormal chest finding of diminished breath
sounds, rhonchi, crackles or wheeze [Grade B]6 suggest community acquired pneumonia.
Diagnostic Tests
Chest xray is recommended for all patients clinically diagnosed of pneumonia [A-
II/Grade A]3,6. Gram stain and culture of appropriate pulmonary secretions [Grade A] 6 and
pretreatment blood cultures (A-II)3 may be requested when drug resistance is suspected and
for etiologic diagnosis.
Hospital Admission
Classify patients by risk categories to help determine the need for hospitalization.
Only moderate and high-risk CAP should be admitted. [GRADE A]6 (See Table 15)
Treatment
Look for symptom resolution. Follow-up chest x-ray is not needed. [Grade A]6
TABLE 15. CLINICAL FEATURES OF PATIENTS WITH CAP ACCORDING TO RISK
Low Risk CAP Moderate Risk CAP High Risk CAP
Stable vital signs Unstable vital signs: Any of the clinical feature of
*RR< 30 breaths/nmin *RR≥30 breaths/min moderate risk CAP plus any
*PR<125 beats/min *PR≥125 beats/min of the following:
*SBP ≥ 90 mmHg *Temp≥40’C or <35’C
*DPB ≥ 60 mmHg
No cr stable comorbid Unstable comorbid condition Shock or signs of
conditions (i.e. uncontrolled diabetes hypoperfusion
No evidence of mellitus, active malignancies, *altered mental state
extrapulmonary sepsis progressing neurologic *urine output ,30 ml/hr
No evidence of aspiration disease, congestive heart hypoxia (PaO2 > 60 mmHg)
Chest X-ray: failure (CHF) Class II-IV, or acute hypercapnea
*Localized infiltrates unstable coronary artery (PaCO2> 50 mmHg)
*No evidence of pleural disease, renal failure on Chest Xray:
effusion nor abcess dialysis, uncompensated *as in moderate risk CAP
*Not progressive within 24 COPD, decompensated liver
hours disease)
Evidence of extrapulmonary
SANTISSIMA TRINIDAD HOSPITAL
PINAGBAKAHAN CITY OF MALOLOS, BULACAN
TEL (044) 791 -7331
These patients are suitable These patients need to be These patients warrant
for outpatient care [Grade hospitalized for parenteral admission in the intensive
A]6 therapy [Grade A]6 care unit [Grade A]6
Ticarcillin-clavulanate 2.25-4.5 g q 6-
B-lactams w/ B- Piperacillin-tazobactam 8h
lactamase inhibitor: 1.5 g q 12h
Sulbactam-Ampicillin 1.5 g q 6-8h Sulbactam-cefoperazone 500 mg q 6h
Imipenem 1-2 g q 8h
Meropenem
Others: 1-2 g q 4-6h
Oxacillin 600 mg q 8h
Clindamycin 500 mg 6-8h
Metronidazole
Supportive Care
In selected patients, switch to oral therapy when signs of infection are resolving within 72
hours. (Grade A) (See Table 16)
Hospital Discharge
Patients with stable vital signs for 24 hours and able to maintain oral intake may be
discharged. (Grade B)