Community-acquired pneumonia: A practical approach to management for the hospitalist
Sharpe, Bradley A.; Flanders, Scott A.
2006-05
Citation
Sharpe, Bradley A.; Flanders, Scott A. (2006). "Community-acquired pneumonia: A practical approach to management for the hospitalist." Journal of Hospital Medicine 1(3): 177-190. <http://hdl.handle.net/2027.42/50681>
Abstract
Community-acquired pneumonia (CAP) is common, and inpatient physicians should be familiar with the most current evidence about and guidelines for CAP management. Our conclusions and recommendations include: Streptococcus pneumoniae is the most common identified cause of CAP requiring hospitalization, whereas Legionella pneumophila is a common cause of severe CAP. The chest radiograph remains an essential initial test in the diagnosis of CAP and should be supplemented by blood cultures sampled prior to antibiotic therapy and sputum for gram stain and culture if a high-quality specimen can be rapidly processed. Once the diagnosis is made, the Pneumonia Severity Index (PSI) should be used to optimize the location of treatment and to provide prognostic information. Absent other mitigating factors, patients in PSI risk classes I, II, and III can safely be treated as outpatients. Hospitalized patients with CAP should be treated promptly with empiric antibiotics. Nonsevere pneumonia should be treated with a parenteral Β-lactam plus either doxycycline or a macrolide. Patients admitted to the intensive care unit should be treated with a Β-lactam plus either a macrolide or a fluoroquinolone as well as be evaluated for pseudomonal risk factors. Most patients with nonsevere CAP reach clinical stability in 2–3 days and should be considered for a switch to oral therapy and discharge shortly thereafter. Patients should receive pneumococcal vaccination, influenza vaccination, and tobacco cessation counseling prior to discharge if eligible. Multiple quality indicators are measured and publicly reported in the management of CAP, which provides hospitals with an opportunity to improve care processes and patient outcomes. Journal of Hospital Medicine 2006;1:177–190. © 2006 Society of Hospital Medicine.Publisher
Wiley Subscription Services, Inc., A Wiley Company
ISSN
1553-5592 1553-5606
Other DOIs
PMID
17219492
Types
Article
URI
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=17219492&dopt=citationMetadata
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