CAP (Community Acquired Pneumonia )

1. CASE PRESENTATION
COMMUNITY-
ACQUIRED
PNEUMONIA (CAP)
DONE BY: RAWAN ALSULAIMANI
PHARM.D
IBN SINA MEDICAL COLLEGE
1

2. OUTLINE :
DEFINITION
SIGN AND SYMPTOMS
CAUSES
COMPLICATION
TREATMENT
SOAP
2

3. 3
Pneumonia
Health
care
associated
pneumoni
a (HCAP)
Nosocomial pneumonia
Hospital
acquired
pneumonia(
HAP)
Community
acquired
pneumonia
(CAP)

4. IT IS AN ACUTE
INFLAMMATION OF THE
PULMONARY
PARENCHYMA ,
CONSOLIDATION OF AIR
SACS .
CAP IS A COMMON AND
POTENTIALLY SERIOUS
ILLNESS .
4
COMMUNITY-ACQUIRED
PNEUMONIA (CAP) :

5. SIGN AND SYMPTOMS
FEVER
RAPID BREATHING AND COUGH WITH OR WITH
OUT SPUTUM
CHEST DISCOMFORT
5

6. 6
Wheezes Stridor
Lung Sound

7. LABORATORY STUDIES :
• CHEST RADIOGRAPHY
• SPUTUM CULTURE
• BLOOD CULTURES
7

8. TYPICAL BACTERIAL CAP
PATHOGENS INCLUDE:
-STREPTOCOCCUS PNEUMONIAE
- HAEMOPHILUS INFLUENZAE
- MORAXELLA CATARRHALIS
THESE 3 PATHOGENS ACCOUNT
FOR APPROXIMATELY 85% OF CAP
CASES.
MOST COMMON OVERALL: S.
PNEUMONIAE 8
Causes :

9. 9

10. TREATMENT
10
Out patient treatment :
Previously Healthy and no
drug resistance for
S.pneumonia
If there drug resistance for
S.pneumonia
o Macrolide (clarithromycin or
Azithromycin )
o ALT : doxycyclin
o Respiratory quinolones (
levofloxacin 750 mg ) or
o Macrolide with high dose 2 g
TID
o OR Cephalosporin
(ceftriaxone )

11.  IN PATIENT TREATMENT
Non - ICU ICU
• Respiratory Quinolones:
Moxifloxacin or Levofloxacin 750
mg
Or
• B-lactam + Macrolide
• Respiratory Quinolones or
azithromycin ceftriaxone
11

12. ADJUNCTIVE THERAPIES
GLUCOCORTICOIDS —
THERE HAS BEEN INTEREST IN USING GLUCOCORTICOIDS AS
ADJUNCTIVE THERAPY TO ANTIBIOTICS IN HOSPITALIZED
PATIENTS WITH CAP IN AN ATTEMPT TO REDUCE THE
INFLAMMATORY RESPONSE TO PNEUMONIA, WHICH IS LIKELY
TO CONTRIBUTE TO THE MORBIDITY OF THE DISEASE.
12

13. HOSPITAL ADMISSION
ALTHOUGH PATIENTS WITH MILD CAP MAY BE
TREATED IN AN OUT PATIENT , PATIENTS WITH
CAP WHO ARE MODERATELY TO SEVERELY ILL
SHOULD BE HOSPITALIZED.
PATIENTS WITH SEVERE CAP WHO REQUIRE
INVASIVE VENTILATION REQUIRE ADMISSION TO
AN INTENSIVE CARE UNIT (ICU)
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14. COMPLICATION :
 BACTEREMIA.
 LUNG ABSCESS.
 PLEURAL EFFUSION.
 DIFFICULTY BREATHING.
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15. PATIENT EDUCATION
REMIND PATIENTS WITH (CAP) TO COMPLY WITH THE
MEDICATION EVEN AFTER THEY EXPERIENCE CLINICAL
IMPROVEMENT.
15

16. 16
SOAP

17. SUBJECTIVE:
17
Personal Information
Patient Initial: S.A
Gender: Male
Age : 77 years old
Social History
SH:
-Married
-Heavy smoker
for 50 years
Past Medical
History( PMH) :
HTN for 10
years
Chief
Complaint
CC:
CAP
Allergies :
no

18. Vital Signs
BP:113/54 mmHg
P :84 B/Min
RR:20/Min
Temp. : 36.9 C
O2 Sat : 93 %
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Objective:
PYSICAL EXAMINATION :
• Productive cough
• SOB
• Abdominal pain
High :184 Cm
Weight :128 Kg

19. 19
commentReference
Range
ResultTest
Indicate for
anemia
[4.5-5.5]4.01 x10^12/LRBC
Normal[4-10]8.26 x10^9/LWBC
Indicate for
anemia
[13-17]10.9 G/DLHGB
Lab Result :

20. ASSESSMENT:
• MANAGEMENT OF CAP BY CEFTRIAXONE
• MANAGEMENT OF HTN BY AMLODIPINE
• TO PREVENT CVA EVENT BY ENOXAPARIN
• TO PREVENT GASTRIC ULCER BY OMEPRAZOL
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21. PLAN :
Reason for useDose and
Frequency
RouteMedication
Treatment of CAP100 mg. ODIVHydrocortisone
Prophylactic of
CVA event
40 mg. ODS.CEnoxaparin
Prophylactic of
gastric ulcer
40 mg. ODIVOmeprazole
Treatment of HTN10 mg .ODPOAmlodipin
Treatment of CAP2 g. ODIVCeftriaxone
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22. REFERENCES:
SHAHIDI BONJAR AH. ( 2016). DRUG DES DEVEL
THER. ANTIBIOTICS THERAPY: A PERSPECTIVE. 10
(5), 541–546..
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