PCAP Report Clerkship
PCAP Report Clerkship
PCAP Report Clerkship
ACQUIRED PNEUMONIA
Epidemiology
Defined as inflammation of the
lung parenchyma
viral infection
airway obstruction
BACTERIAL PNEUMONIA
Pathogenesis
viral infection
colonize trachea
bacteremia
access to lungs
PNEUMONIA
Pathogenesis
PHYSICAL FINDINGS
Oral Zinc: (10 mg/day for <12 mo, 20 mg/day for ≥12 mo) reduces
mortality among children with clinically defined severe pneumonia
2012 PAPP UPDATE IN THE
EVALUATION AND MGMT OF
PCAP
1. Who shall be considered as having community
acquired pneumonia?
WHO SHALL BE CONSIDERED AS
HAVING COMMUNITY ACQUIRED
PNEUMONIA?
• The presence of pneumonia may be considered even without a chest
radiograph in a patient presenting with cough and/or respiratory
difficulty [Recommendation Grade D] plus any of the following
predictors of radiographic pneumonia:
• tachypnea
• fever
• O2 sat < or = to 92% at room air at any age in the absence of any
coexisting illness
WHO SHALL BE CONSIDERED AS
HAVING COMMUNITY ACQUIRED
PNEUMONIA?
• the presence of pneumonia should be determined using a chest
radiograph in a patient presenting with
• cough or respiratory difficulty in the ff situations:
• presence of dehydration aged 3 months to 5 years
• presence of severe malnutrition aged less than 7 years
• high grade fever and leukocytosis aged 3 - 24 months without
respiratory symptoms
2. Who will require admission?
WHO WILL REQUIRE
ADMISSION?
3. What diagnostic aids are initially requested for
pCAP A or pCAP B?
3. What diagnostic aids are initially
requested for pCAP A or pCAP B?
1. CHEST X-RAY may be requested to rule out pneumonia-related
complications or pulmonary conditions simulating
pneumonia [Recommendation Grade D]
1.1. It should NOT be routinely requested to predict end-of-
treatment clinical outcome [Recommendation Grade A].
2. Chest x-ray, complete blood count, C-reactive protein, erythrocyte
sedimentation rate, procalcitonin, or blood culture should NOT be
routinely requested to determine appropriateness of antibiotic usage
[Recommendation Grade D]
4. What diagnostic aids are initially requested for
pCAP C or pCAP D?
4. What diagnostic aids are initially
requested for pCAP C or pCAP D?
1. For pCAP C
• The following ancillary/diagnostic procedures should be done
to determine etiology:
• Gram stain and/or culture and sensitivity of pleural fluid when available
to assess gas exchange:
• Oxygen saturation using pulse oximetry
• Arterial blood gas [Recommendation Grade D]
4. What diagnostic aids are initially
requested for pCAP C or pCAP D?
1. For pCAP C
• The following ancillary/diagnostic procedures may be done
• to determine etiology
• Sputum culture and sensitivity [Recommendation Grade C]
• Blood culture and sensitivity [Recommendation Grade C]
• to predict clinical outcome:
• Chest x-ray PA-lateral [Recommendation Grade B]
• Pulse oximetry [Recommendation Grade B]
4. What diagnostic aids are initially
requested for pCAP C or pCAP D?
1. For pCAP C
• The following ancillary/diagnostic procedures may be done
• to determine the presence of tuberculosis if clinically suspected:
• Mantoux test (PPD 5-TU) [Recommendation Grade D]
• Sputum smear for aid fast bacilli
• to determine metabolic derangement:
• Serum electrolytes [Recommendation Grade C]
• Serum glucose [Recommendation Grade C]
2. For pCAP D, a referral to a specialist should be done [Recommendation
Grade D].
5. When is antibiotic recommended?
5. When is antibiotic
recommended?
1. For pCAP A or B
• cough preparation, elemental zinc , vitamin A, vitamin D, probiotic
and chest physiotherapy should not be routinely given during the
course of illness.
• a bronchodilator may be administered in the presence of
wheezing.
11. What ancillary treatment can be given?
2. For pCAP C,
• oxygen and hydration should be administered whenever applicable.
• Oxygen delivery through nasal catheter is as effective as using nasal
prong.
• a bronchodilator may be administered only in the presence of wheezing.
• Steroid may be added to a bronchodilator.
• a probiotic may be administered.
• cough preparation, elemental zinc, vitamin A, vitamin D and chest
physiotherapy should not be routinely given during the course of illness
• Micronutrient
• Elemental zinc for ages 2 to 59 months to be given for 4 to 6 months
12. How can pneumonia be
prevented?
2. The following may be given to prevent pneumonia:
• Micronutrient.
• Vitamin D3 supplementation