Community-acquired pneumonia (CAP) is a term used to describe an acute lower respiratory tract infection in individuals with signs, symptoms and a new radiographic shadowing for which there is no other explanation and who have not recently been hospitalized. CAP is common and associated with major morbidity, mortality and financial burden. The annual incidence in the community is 5–11 per 1000 adult population, with the reported mortality less than 1% (BTS guideline, 2009). The reported mortality of adults hospitalised with CAP in the UK has varied between 5.7% and 14%. It is the sixth leading cause of death, and the leading infectious cause of death (Maimon, Nopmaneejumruslers and Marras, 2008). The group of most likely causative bacteria in includes Streptococcus pneumoniae, Mycoplasma pneumoniae, Hemophilus influenzae, and Chlamydophila pneumoniae. This essay will appraise the treatment of CAP in an elderly patientwhose care plan can be found in Appendix 1. For the purpose of this essay we will discuss the severity assessment criteria, choice and effectiveness of antibiotics in treatment of severe CAP. We will examine also the management of severe CAP in renal impairment.
Clinical judgment is essential when deciding on the management of all patients with CAP; however doctors may both overestimate and underestimate the severity of CAP, leading to inappropriate treatment. Severity scores may overcome these difficulties by providing objective classiﬁcation of patients into low, intermediate and high risk categories based on robust, validated markers of poor outcome, therefore a severity-based approach to management in community-acquired pneumonia is recommended. The most widely used scores are CURB65, CUR65 and Pneumonia Severity Index (PSI) (Chalmers et al 2010). The British Thoracic Society (BTS guideline, 2009) recommends the CURB65 score as the initial severity assessment strategy in hospitals for CAP; therefore for the purpose of this essay the CURB65...
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