Management of Pneumonia

Assessment and Classification

Pneumonia severity should be assessed using clinical parameters including respiratory rate, oxygen saturation, mental status, and presence of comorbidities 1, 2
Classify pneumonia as mild, non-severe, or severe based on clinical parameters 2
Hypoxemia is a critical indicator of severe pneumonia requiring hospitalization 3
Bilateral or multilobe involvement on chest radiograph indicates higher severity 3

Amoxicillin remains the preferred first-line agent for outpatient pneumonia treatment 1, 2
A macrolide is recommended as an alternative for patients with penicillin hypersensitivity 1
Combined oral therapy with amoxicillin and a macrolide is preferred for hospitalized patients 1
Intravenous options include ceftriaxone or cefotaxime for patients unable to take oral medications 4
Combination therapy with a β-lactam plus either a macrolide or a respiratory fluoroquinolone is recommended for severe pneumonia 4, 5

All patients should receive appropriate oxygen therapy with monitoring of oxygen saturations to maintain SaO₂ >92% 1, 3
Assess for volume depletion and provide intravenous fluids if needed 1
Provide nutritional support in cases of prolonged illness 1, 7

Review patients in the community with pneumonia after 48 hours or earlier if clinically indicated 3
The CRP level should be remeasured and chest radiograph repeated in patients who are not progressing satisfactorily 1
Clinical review should be arranged for all patients at around 6 weeks post-treatment 1

Bronchoscopy should be considered in patients with persisting signs, symptoms, and radiological abnormalities about 6 weeks after completing treatment 1, 6
For patients with pre-existing chronic obstructive pulmonary disease complicated by ventilatory failure, oxygen therapy should be guided by repeated arterial blood gas measurements 1

Delaying antibiotic administration in severe cases - antibiotics should be given immediately when pneumonia is considered life-threatening 1
Failing to consider resistant organisms or atypical pathogens not covered by initial therapy 4
Inadequate oxygen monitoring and supplementation - maintain SaO₂ >92% with appropriate oxygen therapy 1, 5