PCAP

Criteria for admission

• A patient who is moderate to high risk develop
pneumonia-related mortality should be
admitted.
• A patient who is at minimal to low risk can be
managed on OPD basis.
 RISK CLASSIFICATION FOR PNEUMONIA-RELATED MORTALITY
CLASSIFICATION pCAP A or B pCAP C pCAP D
------ Pneumonia I Pneumonia II
Nonsevere Severe Very Severe
VARIABLES
Clinical
1. Dehydration None/ mild moderate severe
2. Malnutrition None moderate severe
3.Pallor none present present
4. Respiratory rate
3-12mos ≥50/min to ≤60/min ≥60/min to ≤70/min >70/min
1-5yrs ≥40/min to ≤50/min >50/min >50/min
>5yrs ≥30/min to ≤35/min >35/min >35/min

5.Signs of respiratory
failure
a. retraction None IC/subcostal Supraclavicular/IC/SC
b. head bobbing None Present Present
c. cyanosis none Present Present
d. grunting none None Present
e. apnea None None Present
f. sensorium none irritable Lethargic/stupurous/
comatose
 CLASSIFICATION pCAP A or B pCAP C pCAP C
------ Pneumonia I Pneumonia I
Nonsevere Severe Severe
Diagnostic aid at
site-of-care
1. CXR findings of
any of the none present present
following:
Effusion; abscess;
air leak or lobar
consolidation
2. Oxygen
sauturation at room 95% <95% <95%
air using pulse
oximetry
ACTION PLAN
1. Site-of-care Outpatient Admit to ward Admit to critical
care facility
2. Follow-up End of treatment
 ANTIBIOTIC RECOMMENDATION
• For patient classified as either PCAP A or B
and is:
a. beyond 2 years of age
b. with high grade fever without wheeze
 ANTIBIOTIC RECOMMENDATION
• For patient classified as PCAP C:
a. should be admistered if alveolar consolidation
on CXR is present.
b. may be administered if:
 Elevated serum CRP
 Elevated serum procalcitonin level
 Elevated white cell count
 High grade fever without wheeze
 Beyond 2 years of age
 ANTIBIOTIC RECOMMENDATION
• For patient classified as PCAP D :
a. a specialist should be consulted.
 Treatment
• Empiric treatment (bacterial etiology):
-PCAP A/B w/o previous antibiotic:
a. Amoxicillin 40-50 mkD, max dose of 1500mg/D, in 3 divided dose
for at most 7days
b. if with hypersensiticity to Amoxicillin:
Azithromycin 10mkD OD x 3days, or 10mkD at day 1 then 5mkD
for days 2-5, max dose of 500mg/D; or
Clarithromycin 15mkD, max dose of 1000mg/D in 2 divided dose
for 7 days.
 Treatment
• Empiric treatment (bacterial etiology):
-PCAP C w/o previous antibiotic and has completed the primary
immunization against Hib:
 Penicillin G 100,000 units/kg/day in 4 divided dose, administered as
monotherapy

- PCAP C w/o previous antibiotic and has not completed the

primary immunization against Hib:
 Ampicillin 100mkD in 4 divided dose, administered as monotherapy

-PCAP C w/o previous antibiotic and above 15 years of age:

 A parenteral non-antipseudomonal B-lactam (B-lactam/B-lactamase
inhibitor combination , cephalosporin, or carbapenem) + extended
macrolide (azithromycin/clarithromycin); or + respiratory fluoroquinolones
(levofloxacin or moxifloxacin) administered as combination therapy.
 Treatment
• Empiric treatment (bacterial etiology):
-PCAP C w/o previous antibiotic and can tolerate oral
feeding and does not require oxygen support:
 Amoxicillin 40-50 mkD, max dose of 1500mg/D, in 3 divided dose for at
most 7days, on an outpatient basis

-PCAP C severely malnourished or suspected to have

MRSA, or classified as PCAP D:
 Referral to specialist is highly recommended

-Patient established to have MTB infection or disease:

 Antituberculous drugs should be started
 Treatment
• Initial treatment (viral etiology):
a. Oseltamivir (30mg BID for ≤ 15kg BW, 45mg BID for >15-23kg, 60 mg
BID for >23-40 kg, and 75 mg BID for >40kg)
b. Ancillary treatment
 Response to Antibiotics
• Decrease in respiratory signs and/or defervescence
within 72hours after initiation of antibiotic
– FAVORABLE
• If a patient with PCAP A/B is not responding to
antibiotics within 72 hours, consider:
– Change the initial antibiotic; or
– Start an oral macrolide; or
– Re-evaluate the diagnosis
 Response to Antibiotics
• If a patient with PCAP C is not responding to
antibiotics within 72 hours, consider:
– Change the initial antibiotic; or
– Start an oral macrolide; or
– Re-evaluate the diagnosis; or
– Refer to specialist (PCAP C/D).
 Response to Antibiotics
• For PCAP C:
– Switch from IV to oral form 3 days after initiation of current antibiotic
is recommended if:
• Responding to the initial antibiotic therapy
• Tolerance to feeding and without vomiting or diarrhea
• Without pulmonary or extrapulmonary complications
• Without oxygen support
– Switch from 3 days of IV Ampicillin to 4 days of Amoxicillin
 Ancillary Treatment
• Oxygen and hydration should be administered whenever applicable.
• A bronchodilator may be administered only in the presence of wheezing.
• A probiotic may be administered.
• Cough preparations, elemental zinc, vitamin A, vitamin D, and chest
physiotherapy should not be routinely given.