ANTIBiotik

What is
pneumonia?

• Pneumonia is an inflammatory illness of the lung.

 What Causes
Pneumonia?

• Pneumonia can result from a variety of causes,

including infection with bacteria, viruses, fungi,
or parasites, and chemical or physical injury to
the lungs.
 What is pneumonia?
• Infection of the lung
parenchyma
• Causative agents
include bacteria,
viruses, fungi

www.netmedicine.com/xray/xr.htm
 How do we classify pneumonia?
• Community Acquired Pneumonia (CAP)
• Nosocomial/Hospital Acquired Pneumonia
• Others, HCAP, VAP
 CAP
• CAP = pneumonia in person not hospitalized
or residing in a long-term care facility for  14
days

Clinical Infectious Diseases 2000;31:347-82

 CAP - Why do we care about it?

• 5.6 million cases annually

• 1.1 million require hospitalization
• Mortality rate =12% in-hospital; near 40% in
ICU patients

Am J Respir Crit Care Med 163:1730-54, 2001

Anamnesis :
1. Demam
2. Fatigue, malaise
3. Sakit kepala
4. Batuk produktif bisa disertai darah, sesak nafas dan nyeri dada
CAP Berat :
5. Memerlukan ventilasi mekanik
6. Syok septic dan memerlukan obat vasopressor
Kriteria Minor :
- Laju nafas >30x/menit
- Pa02 <250
- Infiltrat multilobus
- BUN >20mg/dl
- Leukopenia (<400/mm3)
- Trombositopenia (<100.000/mm3)
- Hipotermia (suhu <30 derajat)
- Hipotensi
 CAP – Modifying Factors

Am J Respir Crit Care Med 163:1730-54, 2001

CAP – Patient Stratification

Am J Respir Crit Care Med 163:1730-54, 2001

 CAP – Algorithms

Am J Respir Crit Care Med 163:1730-54, 2001

 CAP – Algorithms

Am J Respir Crit Care Med 163:1730-54, 2001

 Duration of Therapy

• 5 -7 days - outpatients
• 7-10 days – inpatients, S. pneumoniae
• 10-14 days – Mycoplasma, Chlamydia,
Legionella
• 14+ days - chronic steroid users

Am J Respir Crit Care Med 163:1730-54, 2001

 CAP -The Switch to Oral Antibiotics

• Switch if patient meets the following:

– Inproved cough and dyspnea
– Afebrile on 2 occasions 8 hours apart
• If otherwise improving way waive this criteria
– Decreasing WBC count
– Functional GI tract with adequate PO intake

Am J Respir Crit Care Med 163:1730-54, 2001

 HAP
• Pneumonia occurring ≥48 h post admission
• Excludes infection incubating at time of
admission

Am J Respir Crit Care Med 153:1711-25, 1995

 HAP - Epidemiology
• 5 to 10 cases per 1,000 hospital admissions

• Second most common nosocomial infection

but number one for M & M
• Mortality near 70% in patients with HAP
• Increased length of stay by 7-9 days

Am J Respir Crit Care Med 153:1711-25, 1995

HAP – Stratification

Am J Respir Crit Care Med 153:1711-25, 1995

HAP – Stratification

Am J Respir Crit Care Med 153:1711-25, 1995

HAP – Stratification

Am J Respir Crit Care Med 153:1711-25, 1995

HAP – Stratification

Am J Respir Crit Care Med 153:1711-25, 1995

 HAP – Failure of Therapy
• Incorrect diagnosis – it is not pneumonia
– Atelectasis, CHF, PE with infarction, lung contusion,
chemical pneumonitis, ARDS, pulmonary hemorrhage
• Pathogen resistance
• Host factors that increase mortality
– Age > 60, prior pneumonia, chronic lung disease
– immunosuppression
• Antibiotic resistance
 HAP - Prevention
• Hand washing
• Vaccination
– Influenza
– Pneumococcus
• Isolation of patients with resistant respiratory tract
infections
• Enteral nutrition
• Choice of GI prophylaxis
1. M.R. is a 33-year-old man presenting to the ED with fevers, and chest
pain. His symptoms have persisted for 3 days, and he has a productive
cough with rusty-colored sputum and dyspnea with exertion. He has had
no recent illnesses and no known sick contacts, but he was recently
released from a 2-year period of incarceration. He has tried ibuprofen to
alleviate his fever and chest pain. Past medical history is positive for
asthma, for which he is prescribed fluticasone and albuterol, and
depression, for which he takes sertraline. Vital signs reveal a temperature
of 40.1◦C, heart rate of 128 beats/minute, blood pressure of 130/76 mm
Hg, and respiratory rate of 32 breaths/minute with accompanying oxygen
saturations of 85% on 5 L of oxygen by nasal cannula. Laboratory results
include the following: WBC count, 15,500 cells/μL Hematocrit, 29.3%
Sodium, 133 mmol/L Potassium, 3.8 mmol/L BUN, 23 mg/dL SCr, 0.8
mg/dL Glucose 148, mg/dL pH 7.42 PO2, 61 mm Hg PCO2, 46 mm Hg
HCO3, 28 mEq/L A test for human immunodeficiency virus is negative.
Chest radiograph reveals a right lower lobe infiltrate. What signs,
symptoms, and tests are consistent with CAP in M.R.?
2. What testing should be performed to obtain a
microbiological diagnosis in M.R.?
3. Which antimicrobial agent(s) should be chosen
for the initial management of M.R.?
4. What is the appropriate length of therapy for
M.R.