PCAP - Summary
PCAP - Summary
PCAP - Summary
2. Patients under 5 years old [Recommendation Grade B] and more than 5 years old [Recommendation Grade D]
who are classified as pCAP C but whose chest x-ray is without any of the following: effusion, lung abscess, air leak
or multilobar consolidation, and whose oxygen saturation is >95% at room air can be managed initially on an
outpatient basis.
Clinical Question 4. WHAT DIAGNOSTIC AIDS ARE INITIALLY REQUESTED FOR A PATIENT CLASSIFIED AS
EITHER pCAP C or pCAP D BEING MANAGED IN A HOSPITAL SETTING?
BACKGROUND
2012 UPDATE SUMMARY RECOMMENDATION.
1. For pCAP C,
1.1. The following ancillary/diagnostic procedures should be done
1.1.1. to determine etiology:
1.1.1.1. Gram stain and/or culture and sensitivity of pleural fluid
when available [Recommendation Grade D].
1.1.2. to assess gas exchange:
1.1.2.1. Oxygen saturation using pulse oximetry
[Recommendation Grade D].
1.1.2.2. Arterial blood gas [Recommendation Grade D].
1.2. The following ancillary/diagnostic procedures may be done
1.2.1. to confirm clinical suspicion of multilobar consolidation, lung
abscess, pleural effusion, pneumothorax or pneumomediastinum:
1.2.1.1. Chest x-ray PA-lateral.
1.2.2. to determine appropriateness of antibiotic usage:
1.2.2.1. C-reactive protein (CRP) [Recommendation Grade A].
1.2.2.2. Procalcitonin (PCT) [Recommendation Grade B].
1.2.2.3. Chest x-ray PA-lateral [Recommendation Grade C].
1.2.2.4. White Blood Cell (WBC) count [Recommendation Grade D].
1.2.2.5. Gram stain of sputum or nasopharyngeal aspirate
[Recommendation Grade D].
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1.2.3. to determine etiology:
1.2.3.1. Sputum culture and sensitivity [Recommendation Grade C].
1.2.3.2. Blood culture and sensitivity [Recommendation Grade C].
1.2.4. to predict clinical outcome:
1.2.4.1. Chest x-ray PA-lateral [Recommendation Grade B].
1.2.4.2. Pulse oximetry [Recommendation Grade B].
1.2.5. to determine the presence of tuberculosis if clinically suspected:
1.2.5.1. Mantoux test (PPD 5-TU) [Recommendation Grade D].
1.2.5.2. Sputum smear for acid-fast bacilli
[Recommendation Grade D].
1.2.6. to determine metabolic derangement:
1.2.6.1. Serum electrolytes [Recommendation Grade C].
1.2.6.2. Serum glucose [Recommendation Grade C].
2. For pCAP D,
a referral to a specialist should be done [Recommendation Grade D].
Clinical Question 5. WHEN IS ANTIBIOTIC RECOMMENDED?
2012 UPDATE SUMMARY RECOMMENDATION.
1. For pCAP A or B, an antibiotic may be administered if a patient is
1.1. beyond 2 years of age [Recommendation Grade D]; or
1.2. with high grade fever without wheeze [Recommendation Grade D].
2. For pCAP C, an antibiotic
2.1. should be administered if alveolar consolidation on chest x-ray is present
[Recommendation Grade C].
2.2. may be administered if a patient is with any of the following:
2.2.1. Elevated serum C-reactive protein [CRP] [Recommendation Grade A]
2.2.2. Elevated serum procalcitonin level [PCT] [Recommendation Grade B]
2.2.3. Elevated white cell count [Recommendation Grade D].
2.2.4. High grade fever without wheeze [Recommendation Grade D].
2.2.5. Beyond 2 years of age [Recommendation Grade D].
3. For pCAP D, a specialist should be consulted [Recommendation Grade D].
considered.
2.3 . May refer to a specialist.
3. If an inpatient classified as pCAP D is not responding to the current antibiotic within 72 hours, immediate
consultation with a specialist should be done [Recommendation Grade D].
Clinical Question 10. WHEN CAN SWITCH THERAPY IN BACTERIAL PNEUMONIA BE
STARTED?
BACKGROUND.
2012 UPDATE SUMMARY RECOMMENDATION.
1. For pCAP C,
1.1. switch from intravenous antibiotic administration to oral form 3 days after initiation of current antibiotic is
recommended in a patient who should fulfill all of the following [Recommendation Grade D]:
1.1.1. Responsive to current antibiotic therapy as defined in Clinical Question 8
1.1.2. Tolerance to feeding, and without vomiting or diarrhea
1.1.3. Without any current pulmonary (effusion/empyema; abscess; air leak, lobar consolidation, necrotizing
pneumonia) or extrapulmonary complications; and
1.1.4. Without oxygen support
1.2. switch therapy from three [3] days of parenteral ampicillin to
1.2.1. amoxicillin [40-50 mg/kg/day for 4 days] [Recommendation Grade B].
2. For pCAP D, referal to a specialist should be considered [Recommendation Grade D].