Pharmacotherapy of Pneumonia

PST 06106

Basic Pharmacotherapy

Session 8: Pharmacotherapy of Pneumonia

Learning objectives

By the end of this session students are expected to be able to:

Define pneumonia

Explain pathophysiology of pneumonia

Explain the clinical presentation of bronchitis and pneumonia

Outline diagnosis of bronchitis and pneumonia

Describe pharmacological treatment of bronchitis and pneumonia

Describe monitoring of bronchitis and pneumonia therapy

Activity: Buzzing

•

What

is Pneumonia?

Definition of Pneumonia

Pneumonia

Pneumonia is the inflammation of the lung tissue.

Pneumonia can either be primary (to the causing organism) or secondary to pathological damage in the respiratory system

It occurs in persons of all ages, although the clinical manifestations are most severe in the very young, the elderly, and the chronically ill

.

The most prominent pathogen causing community-acquired pneumonia (CAP) in otherwise healthy adults is S. pneumonia and accounts for up to 75% of all acute cases.

Other common pathogens include M.

pneumoniae

, Legionella species, C.

pneumoniae

, H.

influenzae

, and a variety of viruses including influenza.

Pathophysiology of Pneumonia

Microorganisms gain access to the lower respiratory tract by three routes.

Through inhalation as aerosolized particles, or

via the bloodstream from an

extra pulmonary

site of infection;

Aspiration of oropharyngeal contents which is a common occurrence in both healthy and ill persons during sleep is the major mechanism by which pulmonary pathogens gain access to the normally sterile lower airways and alveoli.

Pathophysiology of Pneumonia CONT…..

When pulmonary defense mechanisms are functioning optimally, aspirated microorganisms are cleared from the region before infection can become established;

However, aspiration of potential pathogens from the oropharynx can result in pneumonia if lung defenses are impaired

Factors that promote aspiration, such as altered sensorium and neuromuscular disease, may result in an increase in the size of the inoculum delivered to the lower respiratory tract, thereby overwhelming local defense mechanisms.

Pathophysiology of Pneumonia CONT…..

Lung

infections with viruses suppress the antibacterial activity of the lung by impairing alveolar macrophage function and mucociliary clearance, thus setting the stage for secondary bacterial pneumonia.

Mucociliary transport is also depressed by ethanol and narcotics and by obstruction of a bronchus by mucus, tumor, or extrinsic compression.

All these factors can severely impair pulmonary clearance of aspirated bacteria hence causing infection in the

lung.

Clinical Presentation And Diagnosis Of Pneumonia

Signs and symptoms

Abrupt onset of fever, chills, dyspnea, and productive cough

Rust-colored sputum or hemoptysis

Pleuritic chest

pain

Clinical Presentation And Diagnosis Of Pneumonia CONT…

Physical examination

Tachypnea and tachycardia

Dullness to percussion

Increased tactile fremitus, whisper

pectoriloquy

, and

egophony

Chest wall retractions and grunting respirations

Diminished breath sounds over affected area

Inspiratory crackles during lung expansion

Clinical Presentation And Diagnosis Of Pneumonia CONT…

Chest radiograph

Dense lobar or segmental infiltrate

Laboratory tests

Leukocytosis with predominance of

polymorphonuclear

cells

Low oxygen saturation on arterial blood gas or pulse oximetry

Sign and symptoms of pneumonia

Activity: Small Group Discussion

What is the first line treatment of Pneumonia?

Pharmacological Treatment Of Pneumonia

Treatment goals of pneumonia includes:

Eradication of the offending organism through selection of the appropriate antibiotic and complete clinical cure

Most cases of viral pneumonia are self-limiting, although therapy of influenza pneumonia with specific antiviral agents (oseltamivir and

zanamivir

) may hasten recovery

.

Treatment of Pneumonia in Adults

First- line

Treatment of Atypical Community Acquired Pneumonias

Pharmacological Treatment Of Pneumonia In Children

Non-severe pneumonia

OR B:

Give the first dose at the clinic and teach the mother how to give the other doses at home.

And

Encourage breasting and feeding.

Pharmacological Treatment Of Pneumonia In Children

Severe Pneumonia

OR

A:

AND

then, If child responds well, complete treatment at home or in hospital with

Pharmacological Treatment Of Pneumonia In Children

Cont

…..

Very severe Pneumonia:

A:

AND

A

:

A

:

Alternatively,

A:

Monitoring Of Pneumonia Therapy

After therapy has been instituted, appropriate clinical parameters such as signs and symptoms and other laboratory markers should be monitored to ensure the efficacy and safety of the therapeutic regimen.

For patients with CAP or pneumonia from any source of mild to moderate clinical severity, the time to resolution of cough, decreasing sputum production, and fever, as well as other constitutional symptoms of malaise, nausea, vomiting, and lethargy, should be noted.

Monitoring Of Pneumonia Therapy Cont.….

Initial resolution should be observed within the first 2 days and progression to complete resolution within 5 to 7 days but usually no more than 10 days.

For patients with HAP, substantial underlying diseases, or both, additional parameters can be followed, including the magnitude and character of the peripheral blood WBC count, chest radiograph, and blood gas determinations.

Monitoring Of Pneumonia Therapy cont.

…

.

Similar to patients with less severe disease, some resolution of symptoms should be observed within 2 days of instituting antibiotic therapy.

If no resolution of symptoms is observed within 2 days of starting seemingly appropriate

antibiotic therapy or if the patient’s clinical status is deteriorating, the appropriateness of initial antibiotic therapy should be critically reassessed.

The patient should be evaluated carefully for deterioration of underlying concurrent disease(s).

Monitoring Of Pneumonia Therapy cont

.….

Additionally, the caregiver should consider the possibility of changing the initial antibiotic therapy to expand antimicrobial coverage not included in the original regimen (e.g.

Mycoplasma, Legionella,

and anaerobes).

Furthermore, the need for antifungal therapy (lipid-based amphotericin B) should be considered.

Some resolution of symptoms should be observed within 2 days of starting proper antibiotic therapy, with complete resolution expected within 10 to 14 days

Key Points

Pneumonia

is an infection of the lung tissue whereby the air sacs in the lungs become infected with microorganisms, fluid and inflammatory cells and hence they lungs fail to work properly.

Diagnosis of pneumonia is based on symptoms and signs of an acute lower respiratory tract infection, and can be confirmed by a chest X-ray showing new shadowing that is not due to any other cause

Penicillins as well as other antibiotics can be used for treatment of Pneumonia as indicated

Evaluation

What

is pneumonia?

What are the signs and symptoms of pneumonia?

How is pneumonia diagnosed?

How is the treatment of pneumonia in adult and children?

Which clinical parameters can be used to monitor pneumonia therapy?

REFER Students to

Handout 8.1:

Classification of Pneumonia and Risk Factors

References

Wells

BG,

DiPiro

J,

Schwinghammer

T (2013),

Pharmacotherapy Handbook

(6

th

Ed). New York, NY: McGraw-Hill.

DiPiro

JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008):

Pharmacotherapy: A Pathophysiologic Approach

(7

th

ed

): New York, NY: McGraw-Hill.

Katz M D., Matthias KR., Chisholm-Burns M A., Pharmacotherapy(2011)

Principles & Practice Study Guide: A Case-Based Care Plan Approach

: New York, NY: McGraw-Hill.

Schwinghammer

TL, Koehler JM (2009)

Pharmacotherapy Casebook: A Patient-Focused Approach

(7

th

ed

): New York, NY: McGraw-Hill.

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