Assessment of disease severity

It is essential that in every patient with a clinical diagnosis of pneumonia an assessment is made to determine the severity of the disease. The use of simple clinical and laboratory parameters can determine very accurately those at high risk of death and forms an important guide to the level of patient monitoring required. This assessment also has an important bearing on antibiotic choice.

Complications:

Medical Care:

Oxygen should be administered to all hypoxaemic patients, and high concentrations (≥35%) should be used in all patients who do not have hypercapnia associated with advanced COPD. Assisted ventilation should be considered at an early stage in all patients who remain significantly hypoxaemic despite adequate oxygen therapy. Most patients with moderate to severe pneumonia also require intravenous fluids and occasionally inotrope support

Antibiotics should be given as soon as a clinical diagnosis of pneumonia is made. If possible, culture specimens should be sent prior to starting antibiotics but such treatment should not be delayed if, for example, a sputum sample is not readily available. In most cases of uncomplicated pneumococcal pneumonia a 7-10-day course of treatment is usually adequate, although treatment is usually required for 14 days or longer in patients with Legionella, staphylococcal or Klebsiella pneumonia.

penicillins
ampicillin	0,5-1,0-2,0	6-8 час.	в/м
amoxicillin	0,5-1,0	8 час.	per os
amoxiqlave	0,5-1,0 0,375-0,625 1,2	8-12 час. 8 час. 6-8 час.	в/м, в/в per os в/в
piperacillin	0,1-0,3 г/кг	6-12 час.	в/в, в/м
oxacillin	0,75	4-6 час.	per os, в/м, в/в
cephalosporins
cefasolin, I	0,5-2,0	8 час.	в/м, в/в
cefalotin, I	0,5-2,0	4-6 час.	в/м, в/в
Cefamandol, II	0,5-1,0	4-8 час.	в/м, в/в
cefuroxim, II	0,75-1,5	8 час.	в/м, в/в
cefotaxim, III	1,0-1,5	6-12 час.	в/м, в/в
ceftriaxon, III	1,0-2,0	12 час.	в/м, в/в
Fluoroquinolones
ciprofloxacin	0,5 0,2-0,4	12 час. 12 час.	per os в/в
ofloxacin	0,2	12 час.	per os
pefloxacin	0,4	12 час.	per os, в/в
levofloxacin	0,5	12-24 час.	per os в/в
tetracyclins
Doxycycline	0,2 0,1	І день след. дни	per os

Formal physiotherapy is not indicated in patients with community-acquired pneumonia; however, assisted coughing is important in patients who suppress cough because of pleural pain. The administration of analgesic drugs should be coordinated with this form of physiotherapy to optimise patient cooperation.

Дата добавления: 2015-11-14