Community-Acquired Pneumonia in Adults

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Martin Kolditz - , Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden (Author)
  • Santiago Ewig - , Augusta Hospitals Bochum Hattingen (Author)

Abstract

BACKGROUND: The clinical spectrum of community-acquired pneumonia ranges from infections that can be treated on an outpatient basis, with 1% mortality, to those that present as medical emergencies, with a mortality above 40%.

METHODS: This article is based on pertinent publications and current guidelines retrieved by a selective search of the literature.

RESULTS: The radiological demonstration of an infiltrate is required for the differentiation of pneumonia from acute bronchitis regardless of whether the patient is seen in the outpatient setting or in the emergency room. For risk prediction, it is recommended that the CRB-65 criteria, unstable comorbidities, and oxygenation should be taken into account. Amoxicillin is the drug of choice for mild pneumonia; it should be given in combination with clavulanic acid if there are any comorbid illnesses. The main clinical concerns in the emergency room are the identification of acute organ dysfunction and the management of sepsis. Intravenous beta-lactam antibiotics should be given initially, in combination with a macrolide if acute organ dysfunction is present. The treatment should be continued for 5-7 days. Cardiovascular complications worsen the patient's prognosis and should be meticulously watched for. Structured followup care includes the follow-up of comorbid conditions and the initiation of recommended preventive measures such as antipneumococcal and anti-influenza vaccination, the avoidance of drugs that increase the risk, smoking cessation, and treatment of dysphagia, if present.

CONCLUSION: Major considerations include appropriate risk stratification and the implementation of a management strategy adapted to the degree of severity of the disease, along with the establishment of structured follow-up care and secondary prevention, especially for patients with comorbidities.

Details

Original languageEnglish
Pages (from-to)838-848
Number of pages11
JournalDeutsches Arzteblatt International
Volume114
Issue number49
Publication statusPublished - 8 Dec 2017
Peer-reviewedYes

External IDs

PubMedCentral PMC5754574
Scopus 85039775836
ORCID /0000-0001-6022-6827/work/142659564

Keywords

Sustainable Development Goals

Keywords

  • Adult, Aged, Anti-Bacterial Agents/therapeutic use, Community-Acquired Infections/diagnosis, Germany, Humans, Middle Aged, Pneumonia/diagnosis, Respiratory Distress Syndrome