| name: | Bacterial Pneumonia |
| also known as: | Bacteria Pneumonia; Lung Infection; Acute Bacterial Pneumonia; ICD 481 |
| also see: | Pneumonia; Pleurisy; Pleural Effusion; Lung Abscess; Viral Pneumonia; Mycoplasma Pneumonia; Legionnaire's Disease; Respiratory Syncytial Virus; Aspiration Pneumonia; Pneumocystis Carinii Pneumonia; Hypersensitivity Pneumonitis; Eosinophilic Pneumonia; Allergic Bronchopulmonary Aspergillosis; Neonatal Pneumonia; Bronchoscopy; ICD |
| description: | Bacterial pneumonia is an infection of the lungs with bacteria, the causes of which include strep infection, staph infection, haemophilus, enterobacteriaceae, pseudomonas, mycoplasma pneumonia and Legionnaire's Disease. There is often a distinction made between community acquired pneumonia, that is, pneumonia acquired outside a hospital setting, and pneumonia or pneumonia acquired in the hospital while in the hospital for another reason. Risk is increased with the very young and the very old, smoking, alcoholism, immunodeficiency disease, chronic illness, diabetes, unsanitary living conditions, and hospitalization (nosocomial), age extremes, AIDS, COPD, malnutrition, unconsciousness resulting in loss of airway protection. Bacterial pneumonia is usually not contagious although viral pneumonia and mycoplasma pneumonia might be. |
| signs & symptoms: | Includes high fever, chills, wet productive cough, shortness of breath, rapid breathing, rapid heartbeat, chest discomfort or pain, fatigue, blue fingernails and lips, rales, egophony. |
| diagnosis: | Based on signs, symptoms, history and exam, as well as chest x-ray showing a patchy or lobar infiltrate, gram stain of the sputum for culture and sensitivity, blood count showing an elevated WBC count with a left shift (towards neutrophils). Rarely, a bronchoscopy is performed if the diagnosis is in doubt. Differential diagnosis includes: viral pneumonia, atypical pneumonia, pulmonary embolism, heart attack, lung abscess, BOOP, fungus infection of the lungs, hypersensitivity pneumonitis |
| treatment: | Involves antibiotics as well as other general supportive measures, such as fluids, humidification, cough medications, pain medicine. Indications for hospital admission include elderly, underlying medical problems of significance, or a toxic presentation, such as coughing up blood, shortness of breath, rapid breathing, cyanosis, inability to complete a 5 word sentence, listlessness, confusion, disorientation. Antibiotic treatment is generally for 10 days, longer for Legionnaire's disease and mycoplasma pneumonia. Failure to improve can include wrong antibiotic, wrong dose, wrong bacteria, or wrong diagnosis. Antibiotic based on empiric evidence: 1. community pneumonia in an otherwise healthy adult: erythromycin, azithromycin, clarithromycin. 2. pneumonia in the elderly: Rx ciprofloxacin (cipro), levofloxacin (levaquin), or augmentin plus erythromycin, azithromycin, clarithromycin. 3. severe community pneumonia in an otherwise health adult: cefotaxime, ceftriaxone, or cefuroxime, or ampicillin/sulbactam (unasyn) plus erythromycin, azithromycin, clarithromycin, or ciprofloxacin (cipro), levofloxacin (levaquin) 4. hospital acquired pneumonia: gentamicin or tobramycin plus piperacillin, mezlocillin, or ticarcillin Antibiotic based on specific bacteria: 1. pneumococcal: penicillin, amoxicillin, ceftriaxone, cefuroxime, cefotaxime, quinolones, vancomycin, erythromycin, clindamycin 2. H. flu: ampicillin, tetracycline, doxycycline, septra/bactrim, ceftriaxone, cefotaxime, chloramphenicol, augmentin, zithromax 3. M. catarrhalis: a 2nd or 3rd generation cephalosporin, or cipro, or tetracycline, doxycycline, or septra/bactrim, augmentin, timentin, erythromycin, azithromycin, clarithromycin 4. meningococcal: high dose penicillin, tetracycline, erythromycin, septra/bactrim 5. staph: methicillin, nafcillin, or oxacillin with or without rifampin or gentamicin, or vancomycin, cefadroxil (duricef), cephalexin (keflex), cephradine (velosef), clindamycin, oxazolidinone, quinolones, septra/bactrim. For meth-resisant strains: vancomycin with or without oxazolidinone, gentamicin, or rifampin 6. legionella: erythromycin, azithromycin or clarithromycin with or without rifampin, or cipro, doxycycline with or without rifampin, or septra/bactrim 7. gram- bacilla especially klebsiella, E. Coli infection: 3rd generation cephalosporin such as cefixime (suprax), ceftizoxime (cefizox), cefotetan (cefotan), cefotaxime (claforan), ceftazidime (fortaz, tazicef, tazidime), ceftriaxone (rocephin), or cefoperazone (cefobid), with or without gentamicin or tobramycin. Alternatives include aztreonam, imipenem/cilastatin, quinolones 8. anaerobic: high dose penicillin, clindamycin, flagyl, augmentin, timentin, imipenem/cilastatin, clindamycin 9. mycoplasma: erythromycin, azithromycin, clarithromycin., doxycycline, or cipro 10. chlamydia: doxycycline, cipro, erythromycin, azithromycin, clarithromycin 11. pseudomonas: gentamicin or tobramycin plus piperacillin, mezlocillin, or ticarcillin, or cipro plus gentamicin or tobramycin or ceftazidime or cefepime, or aztreonam 12. Pneumocystis Carinii Pneumonia: septra/bactrim, depending upon the severity of the infection, as well as steroids such as prednisone, aerosolized form of pentamidine, trimethoprim + dapsone, or clindamycin + primaquine. |
| prevention: | Treat upper respiratory infections completely. Avoid risks. |
| outcome: | Usually curable in 1-2 weeks with treatment. Symptoms of pneumonia improve within 48-72 hours, physical exam findings within 1-2 weeks, and chest x-ray returns to normal within 1-3 months. Unchecked disease can progress to pleurisy, pleural effusion, lung abscess, sepsis, ARDS. The Pneumonia Patient Outcomes Research Team or PORT has a developed a predictor for mortality based on 19 clinical variable. Recurrent pneumonia is seen in bronchiectasis, AIDS, underlying lung disease such as chronic obstructive pulmonary disease, underlying cancer, and in children with immunodeficiency disease. |
skynetMD suggests the following:
| if: | If the person has symptoms suggestive of pneumonia, with a high fever, a wet productive cough, coughing up blood, shortness of breath, rapid breathing, general ill feeling, fatigue, or, if the symptoms continue to progress despite treatment, such as blue fingernails and lips, difficulty breathing, inability to complete a 5 word sentence, listlessness, confusion, disorientation |
| go to: | Go to the doctor or the hospital. |
| if: | If the person has pneumonia and is under the care of a doctor, they should also rest, drink plenty of fluids, use a cool mist humidifier, use a heating pad for chest discomfort, and |
| go to: | Go to the pharmacy for a cool mist humidifier, a heating pad, guaifenesin to keep secretions thin, acetaminophen, aspirin (if older than 19 years) ibuprofen, or naproxen, cough medications (don't use a cough suppressant as coughing is good for a person, coughing helps keep the lungs clear) as well as multivitamin and vitamin C. |
Last updated 7/18/2009