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In GOD We Trust!

ANGONO MEDICS HOSPITAL CPG-CAP


Rainbow Village No.1, Quezon Avenue, Angono, Rizal Form No. AMH MR-037-2017 Rev.01
Page 10f 2

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COMMUNITY ACQUIRED PNEUMONIA IN ADULTS

Name of Patient:______________________________ Case No:____________ Date: _______________

Clinical Diagnosis: Diagnostic Tests:


Cough, fever, difficulty of breathing and/or Chest X-ray (as recommended for all patients clinically
chills within the past 24 hours to less than 2 weeks diagnosed of Pneumonia)
associated with tachypnea (RR>20 breaths/ min.) Gram stain and culture of appropriate pulmonary
tachycardia (CR>100/min) and fever (T>37.8`C with at secretions and pre-treatment blood cultures may be
least one abnormal chest finding of diminished breath requested when drug resistance is suspected and for
sounds, ronchi, crackles or wheezes. etiologic diagnosis.
Classify patients by risk categories to help determine the need for hospitalization.
Only moderate and high risk CAP should be admitted.
Clinical Features according to Risk:
Put a check mark on the signs/symptoms noted on the patient for proper classification/ diagnosis.
LOW RISK MODERATE RISK HIGH RISK

Stable Vital Signs: Unstable Vital Signs: Any of the clinical feature of moderate
RR <30 breaths/ min. RR > 30 breaths/ min. risk CAP plus any of the following:
PR <125 beats/min. PR > 125 beats/ min.
SBP > 90 mmHg Temp > 40`C or < 35`C Shock or signs of hypo perfusion
DBP> 60 mmHg
None or stable co-morbid Unstable co morbid condition ____hypotension
conditions such as the ff: ____altered mental state
No evidence of aspiration ____uncontrolled DM ____urine output <30mL/hr.
____active malignancies ____hypoxia (PaO2<60mmHg) or
Chest X-ray: ____progressing neurologic dse. ____acute hypercapnia
Localized infiltrates ____congestive heart failure (CHF) (PaCO2>50mmHg)
No evidence of pleural effusion ___ unstable coronary artery dse.
Not progressive within 24 hrs. ____renal failure on dialysis Chest X-ray:
____uncomp/decomp.COPD
As in moderate risk CAP
Evidence of extra pulmonary
sepsis (hepatic, hematologic,
gastrointestinal, endocrine)
Suspected Aspiration

Chest X-ray:
Multilobar infiltrates
Pleural effusion or abscess
Progression of findings to >50%
in 24 hrs.
These patients are suitable for These patients need to be These patients warrant admission
outpatient care (Grade A)6 hospitalized for parenteral therapy in the intensive care unit (Grade A)6
(Grade A)6
ER Nurse on Duty: Resident on Duty: Attending Physician:

Because here at AMH – the Patient is our No.1 Concern! RMB/2017


TREATMENT: SUPPORTIVE CARE:
 Initial empiric therapy based on initial risk  Oxygen, hydration and anti-pyretics may be given
stratification is recommended. Among patients if needed
with identified etiologic agent, appropriate
antimicrobials should be instituted. (See
recommended table below)

ANTIBIOTICS DOSAGE ANTIBIOTICS DOSAGE


Low Risk CAP
(all taken orally)
B-lactams: B-lactams w/ B-lactamase
Amoxicillin 500mg TID Inhibitor:
Trim/ sulfonamide: Co-amoxiclav 625mg TID or 1gm BID
Cotrimoxazole 160/800mg BID Sultamicillin 750mg BID
Macrolides: 2nd gen.Caphalosporins:
Azithromycin 500mg OD Cefuroxime Axetil 500mg BID
Clarithromycin 500mg BID
Moderate Risk CAP
Macrolides: 2nd gen, Cephalosporins
Erythromycin IV 0.5-1g q 6h Cefuroxime IV 1.5g q 8h
Azithromycin PO or IV 500mg q 24h Cefoxitin IV (w/anaerobic 1-2g q 8h
Clarithromycin PO or IV 500mg q12h activity)
Gatifloxacin PO or IV 400mg q 24h 3rd gen. Cephalosporins
B-lactams w/ B-lactamase Ceftriaxone IV 1-2g q 24h
inhibitor: Cefotaxime IV 1-2g q 8h
Sulbactam-Ampicillin IV 105g q 8h
High Risk CAP
(all routes are IV)
Macrolides: 3rd gen Cephalosporins:
Erythromicin 0.5-1g q 6h Ceftriaxone 1-2g q 24h
Azithromycin 500mg q 24h Cefotaxime 1-2g q 8h
Clarithromycin 500mg q 12h Ceftizoxime 1-2g q 8h
Gentamicin 3mg/kg q 2h Anti-pseudomonal B-lactams:
Netilmicin 7mg/kg OD Ceftazidime
Tobramycin 3mg/kg q 24h Cefepime 2g q 8h
B-lactams w/ B-lactamase Ticarcillin-clavulanate 2g q 8-12h
inhibitor Piperacillin-tazobactam 3.2g q 6h
Subactam-Ampicillin 1.5g q 6-8h Sulbactam-cefoperazone 2.25-4.5g q 6-8h
Imipenem 1.5g q 12h
Meropenem 500mg q 6h
Others 1-2g q 8h
Oxacillin
Clindamycin 1-2g q4-6h
Metronidazole 600mg q 8h
500mg q 6-8h
Streamlining Empiric Antibiotic Therapy: Hospital Discharge:
 In selected patients, switch to oral therapy  Patients with stable vital signs for 24 hours and
when signs of infection are resolving within 72 able to maintain oral intake may be discharged.
hrs.

Ward NOD: QA Validation: