Clinical features suggesting community-acquired pneumonia  Acute onset (< 2 wk)  Clinical (3/5) - Fever - Cough ± sputum - Dyspnea - Pleuritic chest pain - Crepitation, consolidation  CXR : new infiltration Exclusion last admission in hospital within 3 weeks, immunocompromised hosts Meet all criteria Yes

No

Consider other diagnoses

Communityacquired pneumonia

Admission decision

OPD

IPD

 No cardio-pulm disease : - Clarithromycin (500 mg) 1x2 7-10 d or - Roxithromycin (150 mg) 1x2 7-10 d

ICU decision

 With cardio-pulm disease Oral macrolide (as above) plus - Amoxicillin (500 mg) 2x2 7-10 d or - Augmentin (625 mg) 1x3 7-10 d

IPD

ICU

Clinical Practice Guideline Community-acquired pneumonia Admission decision (at least 1)

(1). Age > 65 yr (2). Coexisting illness COPD, bronchiectasis, malignancy, DM, CRF, CHF, chronic liver disease, chronic alcohol abuse, malnutrition, CVA, post-splenectomy, past admission within 1 year (3). Physical finding - RR > 28/min - SBP < 90 mmHg, DBP < 60 mmHg - PR > 125/min - BT < 35oC or > 40oC - Alteration of consciousness - Evidence of extrapulmonary infection site(s) (4). Labfindings - WBC < 4000/mm3, > 30000/mm3, or absolute neutrophil < 1000/mm3 - SpO2 < 92% (room air) - Cr > 1.2 mg/dl or BUN > 20 mg/dl - Unfavorable CXR: multi-lobar involvement, cavitation, rapid radiographic spreading, pleural effusion - Hct < 30%, or Hb < 9 mg/dl (5). Sepsis or organ dysfunction ICU admission criteria

1 major criteria or 2 minor criteria (1). Major criteria

- Need ventilator - Septic shock

Ceftriaxone 2 g IV OD or Augmentin 1.2 g IV q8hr + Roxithromycin (150 mg) 1x2 or Clarithromycin (500 mg) 1x2

 No risks for P. aeruginosa Ceftriaxone 2 g IV OD + Azithromycin IV  With risks for P. aeruginosa Ceftazidime 2 g IV q8hr + Azithromycin IV

Early clinical response (within 24-48 hr) change IV ATB  oral ATB & discharge

โดยเลือกยาทีค่ รอบคลุมเชือ้ ใกล้เคียงกับยาฉีด ผูป้ ว่ ยทีอ่ าจพิจารณาสังเกตอาการต่อหลังเปลีย่ นยาฉีดเป็ นยารับประทาน ได้แก่ ผูป้ ว่ ยสูงอายุ มีโรคร่วม หรือมีภาวะแทรกซ้อนจากปอดอักเสบ เช่น pleural fluid ฯลฯ ไม่ควรเปลีย่ นยาปฏิชวี นะใน 72 ชัวโมงแรก ่ ยกเว้นมีหลักฐานทีบ่ ่งชีว้ ่า เชือ้ ดือ้ ยา หรือเปลีย่ น การวินิจฉัยโรคเป็นโรคอื่น จัดทาโดย

กมลชนก โป้ชิ ้ว 5102012 ณัฐรดี กาญจนานุชิต 5102057 ณัฐพล อลีนจิตพงศ์ 5102053 ศุภฤกษ์ เลาหพิทกั ษ์ วร 4702094 อัครวุฒิ เกษมไชยานันท์ 5102159 คณะแพทยศาสตร์โรงพยาบาลรามาธิบดี

(2). Minor criteria

- SBP < 90 mmHg - Multilobar involvement - SpO2 < 92% with oxygen supplement Indications of sputum G/S, C/S - ICU admission - Structural lung diseases - Chronic alcohol users - No response to treatment within 72 hr - Patients following physical or laboratory finding in admission criteria

P. aeruginosa risk -Structural lung diseases e.g. bronchiectasis - Broad–spectrum antibiotics for 7 d within the past month - Corticosteroids therapy (prednisolone than 10 mg/day) - Severe malnutrition Reference : สมาคมอุรเวชช์แห่งประเทศไทย (ตุลาคม 2544)

CAP CPG.pdf

Page 1 of 1. Clinical Practice Guideline. Community-acquired pneumonia. No risks for P. aeruginosa. Ceftriaxone 2 g IV OD. +. Azithromycin IV. With risks ...

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