CASE PRESENTATION ON

COMMUNITY ACQUIRED PNEUMONIA

Submitted by : Amar Prasad Chaudhary

V PHARM-D
Department of clinical practice,
MALLIGE COLLEGE OF PHARMACY,Silvepura,Bangalore-90
COMMUNITY ACQUIRED
PNEUMONIA
• Pneumonia is defined as the inflammation of the lungs parenchymal cell so it
will mainly affects alveoli of lungs.
• It is characterized by alveoli filled by mixture of inflammatory exudate, bacteria,
and WBC
• Community-acquired pneumonia (CAP) is infectious pneumonia in a person who
has not recently been hospitalized.
• CAP is the most common type of pneumonia. The most common causes of CAP
vary depending on a person's age, but they include Streptococcus pneumoniae,
viruses, the atypical bacteria, and Haemophilus influenzae.
• Overall, Streptococcus pneumoniae is the most common cause of community-
acquired pneumonia worldwide.
SIGN AND SYMPTOMs
• Fever
• Chills
• Dyspnea
• Productive cough
• Hemoptysis
• Bluish lips
DEMOGRAPHIC DETAILS
• Patient name : ABC
• Age : 23 years
• Sex : male
• Date of admission : 4-12-2019
• Date of discharge : 9-12-2019
SUBJECTIVE EVIDENCE

COMPLAINTS ON ADMISSION
• c/o cough since yesterday
• c/o fever since yesterday
• c/o right chest pain since yesterday ( severe)
PAST MEDICAL HISTORY
• Prehypertensive
• Post bilateral tonsillectomy (2011)
• was admitted for atypical pneumonia 2 years back
PAST MEDICATION HISTORY
Not on medication
Social history
• Appetite : decreased
• Sleep : disturbed
• Bowel and bladder : dysuria
• Diet : mixed
General physical examination
• B.P : 110/70 mm hg
• RR : 28 cycles per min
• Temp : 98F
• Sp02 : 97%
SYSTEMIC EXAMINATION
• CVS : S1 S2 (+)
• CNS : CONCIOUS, ORIENTED
• RS : B/L NVBS
• PELVIC PULSES : FELT
• PA:SOFT
• GCS: conscious, oriented
PROVISIONAL DIAGNOSIS
• Viral fever along with myalgia
• pharyngitis
OBJECTIVE EVIDENCE
4-12-2019
Urine routine
Colour : yellow ( pale yellow)
Protein : present (+ ) ( absent)
Renal profile
Creatinine : 1.35mg/dl (0.9-1.30)
egfr: 134.0 meq/l (136-145)
ESR :19 mm/hr (0-10)
• CBC
MCV : 81 Fl (83-101)
Total count (TC): 22250 cells/cumm (4000-10000)
Neutrophils : 87% (40-80)
Lymphocytes : 09% (20%-40%)
Platelet count: 2.74 lahs/cu mm (1.40-4.50)
(note: monitoring of platelet required as it reduces in sepsis)
• PROCALCITONIN: 13.60 ng/ml (severe bacterial infection, sepsis
or septic shock) (0.1ng/ml)

• LFT
• Direct bilirubin: 0.28 mg/dl (0.0-0.2)
• GGT : 142.00 u/l (.0-60)
ABG Without Lactate (10:35)
pH 7.450 (7.380-7.440)
PCo2 34.00 (35.00-45.00)
P02 57 (75.00-100.00)

20:54
pH 7.460 (7.380-7.440)
PCo2 31.00 (35.00-45.00)
P02 48.00 (75.00-100.00)
5-12-2019
CBC
• TC 31920 cells/cu mm 4000-10000
• Neutrophils 94.6% 40.0-80.0
• Lymphocytes 03.2% 20.0-40.0

• Prothrombin time test:17.3 sec 12.5-15.6

• Platelet count : 2.54 lakhs

• ABG improved to normal due to subject on BIPAP

ABG without lactate (19:56)
• PH 7.490 (7.380-7.440)
• PCo2 25.60 mmHg (35.00-45.00)
• PO2 105.00 mmHg (75.00-100.00)

• Chest x-ray
• Mild inspiratory film
• Haziness in right paracardiac and left mid and lower zones ? consoltation
Sputum smear
• Gram stain
• Ocassionally gram positive cocci (streptococci and micrococci) and
gram negative bacilli
 6/12/2019
• Chest AP (x-ray report)

• Mild inspiratory film.

• Diffuse inhomogeneous haziness noted in bilateral lung firlds? Consolidation
• Bilateral costophrenic angles are hazy? Pleural effusion

• ABG
• Pco2 34.6 mmHg (35.00-45.00)
• Po2 67.00 mmHg (75-100)
CBC
• WBC 21440
• NEUTROPHILLS 90%
• LYMPHOCYTES 08%
7/12/2019
• CBC
• WBC 15200

• 9/12/2019
• WBC 12220
• CREATININE 0.81
GOALS OF THERAPY
• To reduce the sign and symptom of the disease
• To prevent the further complication of the disease
• To cure the infection
ASSESSMENT
From subjective and objective evidence it was found that patient was
suffering from
• bilateral pneumonia, sepsis along with septic shock
• Sepsis induced acute kidney injuiry (resolved)
• Primary immunodeficiency under evaluation
• type1 respiratory failure
 Medication treatment CHART
DAY 1
BRAND NAME GENERIC NAME INDICATION DOSE ROUTE FREQUENCY TIME
(MG)
C. Vizylac Rich Probiotics and Immune 1 cap PO 1-0-0 AF
MVI deficiency
T.pantodac pantoprazole gastitis 40mg PO 1-0-0 BF

Inj.tramazac tramadol analgesics 50mg IV stat

Inj.PCT paracetamol pyretics 1gm IV Stat and sos

Syp.Reswas levodropropizin expectorant 30mg/2mg PO 1-0-1 AF

e+chlorphenira
mine
T.claribid clarithromycin pneumonia 500mg PO 1-0-1 AF

c.antiflu oseltamavir Viral infection 75mg PO 1-0-1 AF

T.dolo paracetamol pyretics 650mg PO sos AF

BRAND NAME GENERIC NAME INDICATION DOSE ROUTE FREQUENCY TIME
(MG)
T.TELECAST-F MONTELUCAST BRONCODIALAT 10/120 PO 0-0-1 PO
ION
T.ABPHYLIN-N ACEBROPHYLLI BRONCHODIALA 100/600 PO 1-0-1 PO
NE AND ACETYL TION
CYSTEINE
INJ.MICROPENE MEROPENEM SEPSIS 1gm IV 1-1-1 IV
M
INJ.LESURIDE LEVOSULPIRIDE GUT MOTILITY 25mg IV STAT & 1-0-1 IV
T.ULTRACET PCT/TRAMADO ANALGESIC 325/18.5 PO STAT PO
SEMI L
INJ.VITNEURION VIT B COMPLEX NEUROPATHY 2 amp IN IV STAT IV
100ML
D 360 VIT D WEAKNESS 6000unit PO 1-0-0 PO
INJ.SOLUMEDR METHYLPREDNI SEPSIS 125mg IV STAT IV
OL SOLONE 40MG 1-1-1
INJ.NORAD NORADRENALI HYPOTENSION 4ml/hr IV CONTINUOUS IV
NE 5mg in 5oml
 DAY2
BRAND NAME GENERIC INDICATION DOSE ROUTE FREQUENCY TIME
NAME (MG)
INJ.MICROPEN MEROPENEM SEPSIS 1gm IV 1-1-1 IV
EM
T.claribid clarithromycin pneumonia 500mg PO 1-0-1 AF

c.antiflu oseltamavir Viral infection 75mg PO 1-0-1 AF

T.pantodac pantoprazole gastitis 40mg PO 1-0-0 BF

T.ABPHYLIN-N ACEBROPHYLLI BRONCHODIAL 100/600 PO 1-0-1 PO

NE AND ATION
ACETYL
CYSTEINE
T.TELECAST-F MONTELUCAST BRONCODIALA 10/120 PO 0-0-1 PO
TION
T.dolo paracetamol pyretics 650mg PO sos AF

Inj.PCT paracetamol pyretics 1gm IV Stat and sos

BRAND NAME GENERIC INDICATION DOSE ROUTE FREQUENCY TIME
NAME (MG)

INJ.TRANEXA Trenaxamic BLEEDING 500MG PO 1-1-1 IV

acid

Inj.EFCORLIN HYDROCORTIS SESPSIS 50MG IV 1-1-1 IV

ONE

INJ.DERIPHYLLI THEOPHYLLINE BRONCHODIAL 1CC IV 1-1-1 IV

N AND ATION
ETIOPHYLLINE

T. SHELCAL CALCIUM LOW CALCIUM 500MG PO 1-0-1 PO

 DAY3
BRAND NAME GENERIC INDICATION DOSE ROUTE FREQUENCY TIME
NAME (MG)
INJ.MICROPEN MEROPENEM SEPSIS 1gm IV 1-1-1
EM
T.claribid clarithromycin pneumonia 500mg PO 1-0-1 AF
c.antiflu oseltamavir Viral infection 75mg PO 1-0-1 AF
T.pantodac pantoprazole gastritis 40mg PO 1-0-0 BF
T.ABPHYLIN-N ACEBROPHYLLI BRONCHODIAL 100/600 PO 1-0-1 AF
NE AND ACETYL ATION
CYSTEINE
T.TELECAST-F MONTELUCAST BRONCODIALA 10/120 PO 0-0-1 AF
TION
INJ.DERIPHYLLI THEOPHYLLINE BRONCHODIAL 1CC IV 1-1-1
N AND ATION
ETIOPHYLLINE
T. SHELCAL CALCIUM LOW CALCIUM 500MG PO 1-0-1 AF
T.HYDROCORT HYDROCORTIS SEPSIS 50MG PO 1-1-1
ONE
INJ.VIT K VIT K Coagulation 10mg in 100ml IV STAT
 DAY 4
BRAND NAME GENERIC NAME INDICATION DOSE ROUTE FREQUENCY TIME
(MG)
INJ.MICROPENE MEROPENEM SEPSIS 1gm IV 1-1-1
M
T.claribid clarithromycin pneumonia 500mg PO 1-0-1 AF
c.antiflu oseltamavir Viral infection 75mg PO 1-0-1 AF
T.pantodac pantoprazole gastritis 40mg PO 1-0-0 BF
T.ABPHYLIN-N ACEBROPHYLLI BRONCHODIAL 100/600 PO 1-0-1 AF
NE AND ACETYL ATION
CYSTEINE
T.TELECAST-F MONTELUCAST BRONCODIALAT 10/120 PO 0-0-1 AF
ION
INJ.DERIPHYLLI THEOPHYLLINE BRONCHODIAL 1CC IV 1-1-1
N AND ATION
ETIOPHYLLINE
T. SHELCAL CALCIUM LOW CALCIUM 500MG PO 1-0-1 AF
T.HYDROCORT HYDROCORTISO SEPSIS 50MG PO 1-1-1
NE
BRAND NAME GENERIC INDICATION
Day
DOSE
5 ROUTE FREQUENCY TIME
NAME (MG)
INJ.MICROPENE MEROPENEM SEPSIS 1gm IV 1-1-1
M
T.claribid clarithromycin pneumonia 500mg PO 1-0-1 AF
c.antiflu oseltamavir Viral infection 75mg PO 1-0-1 AF
T.pantodac pantoprazole gastritis 40mg PO 1-0-0 BF
T.ABPHYLIN-N ACEBROPHYLLI BRONCHODIAL 100/600 PO 1-0-1 AF
NE AND ACETYL ATION
CYSTEINE

T.TELECAST-F MONTELUCAST BRONCODIALAT 10/120 PO 0-0-1 AF

ION
INJ.DERIPHYLLI THEOPHYLLINE BRONCHODIAL 1CC IV 1-1-1
N AND ATION
ETIOPHYLLINE

T. SHELCAL CALCIUM LOW CALCIUM 500MG PO 1-0-1 AF

T.HYDROCORT HYDROCORTIS SEPSIS 50MG PO 1-1-1
ONE
 PROGRESS CHART

PARAMETERS DAY1 DAY2 DAY3 DAY4 DAY 5

BP (MM HG) 90/70 110/70 130/80 130/80 130/80

PULSE (BPM) 140 135 123 100 80

RR ( CPM) 48 35 32 30 28

SPO2 (% @room 97% 97% 98% 96% 99%

temp)
 Planning
discharge medication
BRAND NAME GENERIC NAME DOSE FREQUENCY TIME DAYS
T.FARONEM FAROPENEM 200MG 1-0-1 AF 5
T.CLARIBID CLARITHROMYCIN 500MG 1-0-1 AF 3
T.PAN PANTOPRAZOLE 40MG 1-0-0 BF 5

T.ABPHYLLINE N ACEBROPHYLLINE 100/600 1-0-1 AF 10

/ N-
ACETYLCYSTEINE
T.TELECAST F MONTELUCAST/ 10/120 0-0-1 AF CONTINUE
FEXOFENIDINE
T.DERIPHYLLINE R THEPHYLLINE AND 1-0-1 AF 15
SR ETIOPHYLLINE
T. SHELCAL CALCIUM 500MG 1-0-1 AF CONTINUE
 Pharmacist intervention

• LESURIDE ERROR PRONE ABBRIBATION 25G INSTEAD OF 25MG

• SIGNATURE AND KMC NO. NOT WRITTEN

• DRUG INTERACTION
• NOTHING SIGNIFICANT
Counselling points

• Use of mask in the public place

• Should not smoke
• Drink more fluids
• Wash hands frequently
• Do some aerobic exercises
• If you get hypotension or diarrhea consult with your physician
• Take pantoprazole 30 min before food
THANK YOU