• 11Nov

    Pneumonia treatment in hospital – when is it required?

    Respiratory infections are a major cause of morbidity and mortality throughout the world. Patients at the extremes of age, those with chronic lung disease or poor immunity are particularly at risk. Pneumonia is an infection of the lungs or its respiratory passages. Depending on the source of infection, it is classified as community acquired or hospital acquired pneumonia. In many cases, pneumonia treatment in a hospital may be required.  


    Pneumonia risk factors

    Pneumonia is more commonly seen in patients with certain risk factors. These include cigarette smoking, upper respiratory tract infections, alcohol consumption, steroid therapy, old age, recent influenza infection, chronic lung disease, HIV infection and indoor air pollution.

    Community acquired pneumonia: It is caused by bacteria or viruses. The most common infecting agent is Streptococcus pneumonia. Other bacteria include mycoplasma, legionella, chlamydia, haemophilus influenza, klebsiella and staphylococcus aureus. The viral causes include influenza, parainfluenza, measles, herpes simplex, varicella and coronavirus (SARS associated virus). Most cases occur due to droplet infection due to coughing or sneezing.

    Hospital acquired pneumonia: Hospital-acquired pneumonia is a new episode of pneumonia occurring after admission to hospital. These infections are more serious and require more aggressive treatment.

    Any cough associated with fever should be taken seriously.

    Any cough associated with fever should be taken seriously.

    Clinical presentation

    Pneumonia usually presents as an acute illness in the form of high fever, rigors and shivering. Other features include headache, loss of appetite and vomiting. The respiratory symptoms include breathlessness and cough. The cough is initially non-productive but later the patient coughs out yellowish sputum. It may be pinkish or red when it contains blood. Chest pain may occur when the pleura covering the lungs is also inflamed. The cough and breathlessness may be severe to warrant hospital admission. Presence of frank blood in the sputum is a worrying symptom and requires attention.

    Clinical assessment

    These patients require a thorough examination including chest. An x-ray of chest is usually diagnostic of this condition. Sputum examination and blood cultures are taken to guide antibiotic choice.

    Pneumonia treatment

    Many patients can be treated on OPD basis. In patients with severe illness or in cases with depressed immunity, hospital treatment is required. The indications of admission include:

    • Age more than 65 years
    • Diminished level of consciousness
    • Acute presentation with very high count of white blood cells requiring intravenous antibiotic therapy
    • Difficulty in breathing with respiratory rate more than 30 per minute
    • Coughing of fresh blood in sputum
    • Inability to maintain normal oxygen saturation of blood. Oxygen therapy is given to any patient who develops tachypnoea (rapid breathing), hypoxaemia (low oxygen in blood), hypotension (abnormal fall of blood pressure) or acidosis (fall of pH of blood). The aim is to maintain the oxygen level within normal limits so that vital organ function is maintained. High concentrations of humidified, should be used in all patients. Non-invasive ventilation may have a limited role but early recourse to mechanical ventilation is often more appropriate
    • Requirement of assisted ventilation. Assisted ventilation should be considered at an early stage in those who continue to have low oxygen levels in blood despite adequate oxygen therapy.

    The other supports for treatment include intravenous fluids, antibiotics, pain relief and maintenance of nutrition.

    Physiotherapy 

    Physiotherapy is helpful as it assists in expectoration of infected sputum. This prevents blockage of respiratory passages otherwise collapse of that part of lung may occur.

    Prevention

    Patient should be advised to stop smoking. In some cases, influenza and pneumococcal vaccination is given. It is well known that influenza vaccine reduces the risk of influenza related death in elderly people. Pneumococcal vaccines reduce the incidence of severe pneumococcal pneumonia.

    Pneumonia is bad infection especially when it occurs in the extremes of age groups. A few cases of mild infection may become fine with OPD treatment. Other cases require hospitalization because it may aggravate at any moment resulting in sudden deterioration in health. Any cough associated with fever should be taken seriously and a physician consult should be taken to rule out a serious infection.

    Anna L.

    It’s all about health!
    I have academic background in drugs related Chemical Technology, as well as extensive professional experience in pharma and medical companies. My main area of interest is everyday life medicine. The goal of my articles is to give people informative answers to the questions that bother them, to dispel doubts and some common misbeliefs and also to inspire everyone to keep healthy lifestyle.

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