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Today is World Pneumonia Day. And this year too, the day reiterates our commitment to the fight against pneumonia, which is treatable in most cases. Hence, deaths due to pneumonia are largely preventable.
Immunization for at-risk individuals and/or early and accurate diagnosis followed by appropriate antibiotic treatment can save lives.
Here are some quick facts about pneumonia.
- Pneumonia is a public health concern and can range in seriousness from mild to life-threatening.
- The most common type of pneumonia is community-acquired pneumonia, which occurs outside of hospitals or other health care facilities. The other forms of pneumonia are hospital-acquired pneumonia, healthcare acquired pneumonia and aspiration pneumonia.
- Pneumonia is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems. Smoking, overcrowding living conditions and concurrent respiratory viral infections are few other risk factors for pneumonia.
- Etiopathogens: Respiratory viruses, bacteria, both typical (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) and atypical (Legionella spp, Mycoplasma pneumoniae, Chlamydia pneumoniae), including Pseudomonas and methicillin-resistant Staphylococcus aureus (MRSA)
- Diagnosis: Presence of an infiltrate on chest x-ray in a patient suspected of pneumonia (fever, cough, dyspnea and raised white cell count) is usually confirmatory. Pneumocystis cariniipneumonia will give a false-negative x-ray.
- Treatment: Start antibiotic (empirical) ideally, within 4 hours of presentation for inpatients and within 1 hour of presentation for critically ill patients.
o Outpatient treatment: Monotherapy with either a macrolide (eg, azithromycin) or doxycycline or combination therapy with a beta-lactam plus a macrolide or doxycycline. Selection among these agents depends on patient comorbidities and risk factors for infections with drug-resistant S. pneumoniae.
o Inpatient treatment: IV beta-lactam + a macrolide/doxycycline or monotherapy with a respiratory fluoroquinolone for most inpatients, including patients at risk for pseudomonas or MRSA
o Intensive care treatment: IV beta-lactam + either a macrolide or doxycycline or a respiratory fluoroquinolone; regimens should be expanded for patients with risk factors for Pseudomonas or MRSA
- Tailor treatment regimen to target the pathogen for patients in whom a causative pathogen has been identified.
- Treat all patients until afebrile and clinically stable for at least 48 hours and for a minimum of 5 days. Patients with severe pneumonia or chronic comorbidities need to be treated for at least 7-10 days.
- Re-evaluate the patient, if there is no response to antibiotic therapy within 72 hours; look for complications and reconsider the diagnosis and empiric therapy.
- Prevention: Smoking cessation, influenza vaccination for the general population, and pneumococcal vaccination for at-risk populations
Dr KK Aggarwal
Padma Shri Awardee
President Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA