PRESENTATION ON COMMUNITY ACQUIRED PNEUMONIA
BY
DAVID TAIWO ONORINODE
PHC/18/19/254929
SUBMITTED TO THE DEPARTMENT OF CLINICAL PHARMACY AND PHARMACY
ADMINISTRATION, FACULTY OF PHARMACY,
DELTA STATE UNIVERSITY, ABRAKA
OCTOBER,2023
TABLE OF CONTENT
COVER PAGE
TABLE OF CONTENT
ABSTRACT
CLINICAL MANIFESTATION
CAUSES
CASE STUDY
EVALUATION OF THERAPY
CONCLUSION
REFERENCES
ABSTRACT
Community-acquired pneumonia (CAP) is one of the most common infectious diseases and an important
cause of mortality and morbidity worldwide.Typical bacterial pathogens that cause CAP include
Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. However, with the
advent of novel diagnostic technologies, viral respiratory pathogens are increasingly being identified as
frequent etiologies of CAP.
Adequate therapy for CAP includes coverage for S pneumoniae and atypical bacterial pathogens.
Treatment options for CAP in outpatients with no comorbidities and no risk factors for drug-resistant S
pneumoniae include the following; Amoxicillin, a macrolide antibiotic and doxycycline.
INTRODUCTION
Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid
or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A
variety of organisms, including bacteria, viruses and fungi, can cause pneumonia
CLINICAL MANIFESTATIONS
The signs and symptoms of pneumonia vary from mild to severe, depending on factors such as the type
of germ causing the infection, and your age and overall health. Mild signs and symptoms often are
similar to those of a cold or flu, but they last longer. Signs and symptoms of pneumonia may include:
Fever, sweating and shaking chills
Cough, which may produce phlegm
Chest pain when you breathe or cough
Shortness of breath
Fatigue
Nausea, vomiting or diarrhea
CAUSES
Pneumonia is classified according to the types of germs that cause it and where you got the infection.
Community-acquired pneumonia
Community-acquired pneumonia is the most common type of pneumonia. It occurs outside of hospitals
or other health care facilities. It may be caused by: bacteria, bacterial-like organisms such as
mycobacteria, viruses and fungi
Hospital-acquired pneumonia
Some people catch pneumonia during a hospital stay for another illness. This type of pneumonia can be
serious because the bacteria causing it may be more resistant to antibiotics
Aspiration pneumonia
Aspiration pneumonia occurs when you inhale food, drink, vomit or saliva into your lungs.
CASE STUDY
DEMOGRAPHICS
Mrs E.D, a 54yrs old female, admitted to medicine ward on 7th Oct., 23. Married with 9 children, No
family history of any known Chronic illness
CHEIF COMPLAINT: Fainting
HISTORY OF PRESENT ILLNESS
The 54 yrs old woman presented with complaints of;
fainting 2 days ago
Hemoptysis of two days
she was in her usual state of health until 2 days prior to Presentation when she collapsed when
pounding palm fruits. There was associated loss of consciousness from which she recovered
after several beats and pouring of water from people around. She felt dizzy prior to the collapse.
That same day she coughed out pellets of Frank blood. The cough started that same day. There's
weight loss, Nill drenching night sweats, or contact with person that has prolonged cough. The
cough us worse on standing, there's associated difficulty in breathing and chest pain. Presented
to the hospital today having had the second episode of hemoptysis.
Not asthmatic, no history of heart disease or any other chronic ailments
Not hypertensive or diabetic
O/E: mild respiratory distress, afebrile,not pale, anicteric, acyanosed, not dehydrated, nil pedal oedema
Vitals: BP= 100/60mmHg, PR = 70bpm, RR= 26cpm, SPO2= 97% RBS = 97
Chest: Crepitation on both upper lung zones.
CNS: Conscious, alert and well oriented
Other systems: Normal
Assessment: Community acquired pneumonia (CAP), R/O Koch's disease.
PLAN
Admit
IVF 500mls N/S 8hrly,
IV Amoxiclavn 1.2g 8hrly
Tab azithromycin 500mg daily
Do Malaria Parasite test, FLP, EU/Cr, Urinalysis, CRP, ESR
RESULT OF INVESTIGATIONS
FBC: PCV= 38%, WBC = 17300, Neutrophils = 81, Lymphocytes= 13, PLT = 250,000, CRP= 150mg/L
Lipid profile and E/U/Cr essentially normal
MP= Positive
ECG: Normal Sinus rhythm, T-wave abnormality,, Consider abnormal ischaemia
Prolonged QT= Abnormal ECG
Assessment: CAP, R/O Koch's disease
PLAN
Do Sputum M/C/S, AAFB
Tab artemeter/Lumefantrine 80/480mg bd x3/7
Syr. Boncholyte 10mls tds
Supplementary O2 if oxygen saturation goes on
Cont other mgt
DAY 2 on Admission
54yr old being managed as a case of CAP, R/O Koch's disease
Nil fresh complaint
Nil episode of hemoptysis
O/E: no obvious distress, afebrile, anicteric, not pale, not dehydrated, Nil oedema
: PR= 76bpm, BP 90/71mmHg, RR= 28, SPO2=98
Assessment: CAP
PLAN: Cont Mgt
DAY 3
Getting meds as prescribed
Temperature of 37.5°C over the night
Had episodes of cough this morning
O/E:GCS
PR= 84bpm, BP = 107/74mmHg, S1&S2 heard RR= 20cpm, SPO2= 98% in room air
Chest is clear
Assessment: CAP, R/O Koch's disease
ECG: Normal Sinus rhythm, T-wave abnormality Consider anterior ischaemia, prolonged QT- abnormal
ECG.
PLAN
D/C IVF, ensure liberal fluid intake
Repeat ECG
Do Toponin
KIV Echo and continue other mgt
DAY 4
Getting meds as prescribed
Still coughing, no hemoptysis
PR= 84bpm, No= 107/74mmHg, RR= 20cpm, SPO2= 98% in room air, Chest is clear
Assessment: CAP
ECG : Same as previous finding
Troponin = 4:1
PLAN
Discharge home on oral medications
Tab Amoxiclav 625bd x5/7
Tab Azithromycin 500mg daily
To do Echo on OPD basis
KIV chest CT
Counsel patient on avoidance of stressful work
To see in one week time for follow up
EVALUATION OF THERAPY
Normal Saline: An infusion for water and electrolyte replacement
Amoxiclav: It's an antibiotic used for beta lactamase producing bacteria including community
acquired pneumonia.
Azithromycin: It's a macrolide antibiotic, which is bacteriostatic in action, can be bacteriocidal in
high concentration.
Artemeter/Lumefantrine: It's an ACT used as first line treatment of uncomplicated P.
Falciparum malaria.
Broncholyte: It's used in conditions associated with congestion of bronchi such as emphysema
with bronchitis, asthma etc
DRUG THERAPY PROBLEMS
Dose too high : Nill
Dosage too low : nill
Drug interaction: nill
Non adherence: nill
Need for additional therapy: Doxycycline 100mg bd should be added to the treatment therapy according
to the recommendation of American thoracic society and infectious diseases society of America, as this
will aid in improving the clinical symptoms.
Unnecessary drug therapy: nill
Adverse Drug reaction: Nill
Wrong Drug: nill
PHARMACEUTICAL CARE PLAN
Drug focused intervention:
Patient is advised to complete medication and use as Prescribed
Patient was advised to take medication at the same time of the day Everytime.
Patient was Advised to take one tablet of azithromycin daily, and one tablet of Amoxiclav twice
daily (12hrly) for 5 days
Patient Focused intervention:
Patient was advised to return to the clinic for follow up after one week
Patient was advised to avoid hard nd stressful works
Patient was advised to drink water liberally
GOALS OF THERAPY
To improve patient's quality of life
To prevent spread of infection
To improve patient's symptoms
OUTCOMES
Clinical Outcomes
Signs of hemoptysis was resolved, as no bloody sputum was observed following treatment
Severity of cough subsided
Economical Outcomes
Cost of therapy was affordable for Patient
Humanity Outcomes
Patient feels better and not weak and fit to resume normal activities
Length of hospital stay was minimal
CONCLUSION: Pneumonia is an infectious diseases that can be caused by several factors and it may lead
to life threatening conditions if not properly managed. It can also be contagious.
REFERENCES
Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al. Community-Acquired
Pneumonia Requiring Hospitalization among U.S. Adults. N Engl J Med. 2015 Jul 30. 373 (5):415-27.
Musher DM, Thorner AR. Community-acquired pneumonia. N Engl J Med. 2014 Oct 23. 371 (17):1619-
28.
Manohar P, Loh B, Nachimuthu R, Hua X, Welburn SC, Leptihn S. Secondary Bacterial Infections in
Patients With Viral Pneumonia. Front Med (Lausanne). 2020. 7:420
