Expectations
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The pathogens that cause pneumonia include viral and bacterial. Viral pneumoniae causes flu-like symptoms that, in most cases, resolve on its own in people <65 y/o. However, the most severe bacterial pneumoniae, including Streptococcus pneumoniae and M. pneumoniae, might lead to Community-acquired pneumonia (CAP). Pneumonia can be mild and have symptoms of fever and productive cough; if acute, it can lead to sepsis and respiratory distress. Pneumonia is the second most common illness-causing hospitalizations, and that leads to death (Ramirez, 2024).
In young adults, the most typical causative microbe includes the atypical, such as Legionella spp, M. pneumonia; the typical, S. pneumoniae; and viruses that include but are not limited to influenza A and B viruses, COVD, RSV, and parainfluenza viruses. The first line of treatment for bacterial pneumonia includes amoxicillin PO 1 gm tid x 7-10 days, amoxicillin-clavulanate, a macrolide such as azithromycin, clarithromycin, or doxycycline—also, second and third-generation cephalosporins, or respiratory fluoroquinolones. The patient should start feeling improvement in signs and symptoms within two days of initiation of treatment (Ramirez, 2024).
Among the geriatric population, the organisms that cause pneumoniae include M. pneumoniae and S. pneumoniae, and the geriatric population is the most vulnerable with their fragile autoimmune system, which usually contracts pneumonia after a cold or flu (CDC, 2023).
Treatment in adults >65 y/o and empiric treatment for the most causative community-acquired pneumonia, streptococcus pneumoniae, and the algorithm is as follows: First, one must determine if the patient has pneumonia, in which be determined by an X-ray, and CRP helps distinguish between viral and bacterial pneumonia, if positive, one must explore previous comorbidities, smokes, alcohol dependent and recent antibiotic treatment, once empiric treatment is established; then, wait for the results from CBC, urine, and sputum, then adjust treatment if necessary (Sucher et al., 2020).
The algorithm is as follows: if penicillin allergy or other intolerance, if not, Amoxicillin-clavulanate plus a macrolide such as an azithromycin or cl clarithromycin; however, this must be avoided if a patient presents with prolonged QT interval and risks for QT include hypokalemia, or hypomagnesemia, and bradycardia. If allergic to penicillin, then cephalosporin or if advanced COPD, it must include coverage of antibiotics should include Enterobacteriaceae, E. coli, and Klebsiella spp, and treatment includes respiratory fluoroquinolone, lefamulin, or a tetracycline such as omadacycline in the form of inhalants. If penicillin allergy or other intolerance and tolerate cephalosporins, then third-generation cephalosporin, plus a macrolide, azithromycin, or clarithromycin, is preferred over doxycycline. A 5-day course for most patients and a follow-up visit or within a few days of treatment to ensure improvement and afebrile (Sucher et al., 2020).
The determination to hospitalize a patient with pneumonia, the symptoms could include sharp or stabbing chest pain that is worse with coughing or inhalation, shortness of breath, O Sat of < 92% on room oxygen, and cough with bloody or greenish sputum—fever of more than 102, and changes of mental status. Seniors with pneumonia are admitted to the hospital, and treatment includes oxygen and, at times, mechanical breathing assistance, humidifier, inhalant steroids, fluid, pain medication, and surveillance.
References
Center for Disease Control. (2023). Pneumococcal disease. Center for Disease Control and Prevention https://www.cdc.gov/pneumococcal/index.html
Ramirez, J. A. (2024). Overview of community acquired pneumonia in adults. UpToDate. https://www.uptodate.com/contents/overview-of-community-acquired-pneumonia-in-adults
Sucher, A., Knutsen, S., Falor, C., & Mahin, T. (2020). Updated clinical practice guidelines for community-acquired pneumonia.https://www.uspharmacist.com/article/updated-clinical-practice-guidelines-for-communityacquired-pneumonia
Xia, X., Gao, Q., Ge, X., Liu, Z., Di, X., Sun, X., & Yang, Y. (2021). Chemoradiotherapy Is Superior to Radiotherapy Alone in Esophageal Cancer Patients Older Than 65 Years: A Propensity Score-Matched Analysis of the SEER Database. Frontiers in oncology, 11, 736448. https://doi.org/10.3389/fonc.2021.736448
