Management Approach for Pneumonia

Severity Assessment

The British Thoracic Society recommends severity assessment as the key to planning appropriate management both in the community and hospital settings 2
Validated severity assessment tools such as the Pneumonia PORT prediction rule and the British Thoracic Society rule should be used to stratify patients into severity classes 3
Regular reassessment of severity during the course of illness is mandatory to adjust management appropriately 2

The American College of Physicians recommends that patients in PORT risk Classes I and II should be considered for outpatient treatment 3
For healthy adults without comorbidities, amoxicillin 1g three times daily is the first-choice antibiotic, as recommended by the American Academy of Family Physicians 1
Patients should be advised to rest and maintain adequate hydration, take simple analgesia such as paracetamol for pleuritic pain, and consider nutritional supplements in prolonged illness, as suggested by the British Thoracic Society 2

Most patients can be adequately treated with oral antibiotics, according to the British Thoracic Society 4
Combined therapy with amoxicillin and a macrolide is preferred for hospitalized patients, as recommended by the Infectious Diseases Society of America 4
Provide appropriate oxygen therapy with monitoring of oxygen saturations to maintain PaO2 >8 kPa and SaO2 >92%, as suggested by the American Thoracic Society 4

For patients without risk factors for Pseudomonas aeruginosa, use a non-antipseudomonal β-lactam plus a macrolide or a respiratory fluoroquinolone, as recommended by the American College of Chest Physicians 1
Patients with severe CAP admitted to ICU should be managed by specialists with appropriate training in intensive care and respiratory medicine, according to the Society of Critical Care Medicine 4

Treat patients for a minimum of 5 days and ensure they are afebrile for 48-72 hours with no more than 1 CAP-associated sign of clinical instability before discontinuing therapy, as recommended by the Infectious Diseases Society of America 1
Arrange clinical review for all patients at around 6 weeks, either with their general practitioner or in a hospital clinic, as suggested by the British Thoracic Society 4

For suspected or confirmed influenza pneumonia, add oseltamivir to the treatment regimen, as recommended by the Centers for Disease Control and Prevention 1
For patients with pre-existing COPD complicated by ventilatory failure, guide oxygen therapy by repeated arterial blood gas measurements, according to the American Thoracic Society 4

Delayed antibiotic administration can increase mortality, as reported by the American College of Emergency Physicians 1
Overuse of fluoroquinolones should be avoided to prevent development of resistance, as recommended by the Centers for Disease Control and Prevention 1