Reply to Two discussions (Pneumonia)

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DISCUSSION POST #1 Reply to Jaspreet

Pneumonia is inflammation of the lungs parenchyma that has multiple pathogens. Some of the common causative agents include bacteria, viruses, fungi and parasites (Sattar et al., 2023). Whether a practitioner is treating a 23 year old or a 66 year old with pneumonia, the primary factor to consider are the co-morbidities. As we age, the functionality of our bodies decreases, meaning the immune system functionality also decreases. So when considering taking care of an older population it is important to keep in mind of the co-morbidities.  For patients with comorbid conditions, the regimen is fluoroquinolone or betalactams + macrocodes (Sattar et al., 2023).  For patients with no combined conditions we can use macrolide and doxycycline (Sattar et al., 2023). Since hospital acquired pneumonia is very common it is very important to assess whether a patient needs to be inpatient or if they can get treated from. home. In order to assess risk quantification an assessment tool called the CURB-65 may be utilized (Sattar et al., 2023). In the acronym CURB, the "C" stands for confusion, "U" is for uremia meaning BUN that is greater than 20mg/dL, respiratory rate greater then 30 breaths per minute, "B" is for blood pressure usually less than 90/60 mmHg and the age is greater than 65 years old (Sattar et al., 2023). If the total is less than 4 it indicates ICU admission (Sattar et al., 2023). For inpatient non ICU patients, the recommended treatment would be fluoroquinolone or macrolide along with beta-lactam (Sattar et al., 2023). In the inpatient ICU setting the recommended treatment would be a beta-lactam with a macrolide or a beta- lactam with fluoroquinolone (Sattar et al., 2023).

DISCUSSION POST # 2 Ashlesha

Pneumonia is an inflammation of the air sacs of one or both lungs caused by bacteria, viruses, or fungi. Alveoli fill with fluid or pus in this condition, making breathing difficult. Viral and bacterial pneumonia are both familiar and contagious and spread by inhalation of airborne droplets from sneezing or coughing. Fungal pneumonia spreads from person to person. (CDC,2022) Common viral pneumonia in the USA is Influenza, treated with amantadine hydrochloride and rimantadine hydrochloride. In immunocompromised patients, RSV is treated with Ribavirin, PIV pneumonia mostly with supportive treatment, and aerosolized and oral ribavirin. (Zab, 2023).

In bacterial pneumonia, typical pneumonia is caused by Streptococcus pneumonia, Haemophilus influenza, Staphylococcus aureus, Group A streptococci, Moraxella catarrhalis, anaerobes, and aerobic gram-negative bacteria (Sattar & Sharma, 2021). Atypical pneumonia is caused by Legionella, Mycoplasma pneumonia, Chlamydia pneumonia, and Chlamydia psittaci (Sattar & Sharma, 2021). Cash et al. (2021) state that the most common pathogen is S.Pneumonia, and the second most is H.Influenza.

           As a primary care provider, I will not treat 23-year-old and 66 years older patients with COPD and DM-II because they do not have the same immunity, and more on Pneumonia is a leading cause of death in children younger than age five and older than 65 years. (Cash et al., 2021) I would consider hospitalization if my patient was more youthful than six years, if they had suspected virulent strain pneumonia (MRSA), appeared toxic, had severe shortness of breath, have worsening symptoms despite treatment, had O2 saturation lower than 88% on room air (unless they have COPD or use home 02 then it varies by condition), or if I were concerned about the level of observation or medication adherence outpatient. Hospitalization may require frailty status and CURB-65 severity score. CURB-65 stands for confusion, BUN>19 mg/dl, RR>30/min, systolic BP<60 mmHg, and age >65. For a score of 0-1, outpatient treatment is advised. If the total score is two or more, it indicates hospital admission; if the score is three or more, ICU admission. (Sattar & Sharma, 2021). Recommended therapy for different settings is as follows:

Outpatient Setting: For patients having comorbid conditions (e.g., diabetes, malignancy, etc.), the regimen is fluoroquinolone or beta-lactams + macrolide. Macrolide or doxycycline can be used empirically. Testing is usually not performed as the empiric regimen is almost always successful. (Sattar & Sharma, 2021).

Inpatient Setting (non-ICU): Recommended therapy is fluoroquinolone or macrolide + beta-lactam.

Inpatient Setting (ICU): Recommended therapy is beta-lactam + macrolide or beta-lactam + fluoroquinolone.

MRSA: Vancomycin or linezolid can be added. The preferred medication for patients with comorbidities or antibiotic use in the past three months would be Levaquin. (Sattar & Sharma, 2021).