Severe Pneumonia in the Elderly: Risks, Treatment, and Prevention

, Winthrop University Hospital, Mineola, NY

Disclosures

Medscape General Medicine. 1998;1(3) 

In This Article

Tables

Table I - Outpatient Community-Acquired Pneumonia with Comorbidity and/or 60 Years of Age or Older

  • Probable Organisms

    • Streptococcus pneumoniae

    • Respiratory viruses

    • Haemophilus influenzae

    • Aerobic gram-negative bacilli

    • Staphylococcus aureus

    • Miscellaneous

      • Moraxella catarrhalis, Legionella species,

      • Mycobacterium tuberculosis, endemic fungi

  • Therapy

    • Second-generation cephalosporin
           OR

    • Beta-lactam/beta-lactamase inhibitor
           OR

    • Trimethoprim-sulfamethoxazole
           +

    • Macrolide or quinolone

Table II - Hospitalized Patients with Community-Acquired Pneumonia with Comorbidity and/or 60 Years of Age or Older

  • Probable Organisms*

    • Streptococcus pneumoniae

    • Haemophilus influenzae

    • Aerobic gram-negative bacilli

    • Legionella species

    • Staphylococcus aureus

    • Chlamydia pneumoniae

    • Respiratory viruses

    • Miscellaneous

      • Mycoplasma pneumoniae, Moraxella catarrhalis,

      • Mycobacterium tuberculosis, endemic fungi

  • Therapy

    • Second or third-generation cephalosporin
           OR

    • Beta-lactam/beta-lactamase inhibitor
           +

    • Macrolide or quinolone

* Source of infection can be polymicrobial

Table III - Severe Community-Acquired Pneumonia

  • Respiratory rate > 30 breaths/min

  • Need for mechanical ventilation

  • Chest radiography findings:

    • 50% increase in the infiltrate in 48 hours

    • Bilateral multilobar involvement

  • Presence of shock

  • SIRS (systemic inflammatory response syndrome) or vasopressors to support blood pressure

  • Severe lung injury (PaO2/FiO2 ratio < 250mmHg)

  • Urine output < 20 cc/hr

  • Acute renal failure requiring dialysis

Table IV - Hospitalized Patients with Severe Community-Acquired Pneumonia

  • Probable Organisms

    • Streptococcus pneumoniae

    • Legionella species

    • Aerobic gram-negative bacilli

    • Mycoplasma pneumoniae

    • Respiratory viruses

    • Miscellaneous

      • Haemophilus influenzae, Mycobacterium tuberculosis, endemic fungi

  • Therapy

    • Macrolide
           +/-

    • Third-generation cephalosporin with anti-Pseudomonas activity
           OR

    • Other anti-pseudomonal agents such as imipenem/cilastatin, ciprofloxacin

Comments

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