Bacterial pneumonia: Difference between revisions

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Revision as of 17:00, 24 January 2012

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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Philip Marcus, M.D., M.P.H.[2]

Overview

Pathophysiology

Treatment

Antibiotics are the treatment of choice for bacterial pneumonia. The antibiotic choice depends on the nature of the pneumonia, the microorganisms most commonly causing pneumonia in the geographical region, and the immune status and underlying health of the individual. In the United Kingdom, amoxicillin is used as first-line therapy in the vast majority of patients who acquire pneumonia in the community, sometimes with added clarithromycin. In North America, where the "atypical" forms of community-acquired pneumonia are becoming more common, clarithromycin, azithromycin, or fluoroquinolones as single therapy, have displaced the amoxicillin as first-line therapy. Local patterns of antibiotic-resistance should always be considered when initiating pharmacotherapy. In hospitalized individuals or those with immune deficiencies, local guidelines determine the selection of antibiotics. These antibiotics are typically given through an intravenous line.

Treatment of gram-positive organisms

Streptococcus pneumoniae - amoxicillin (or erythromycin in patients allergic to penicillin); cefuroxime and erythromycin in severe cases.
Staphylococcus aureus - flucloxacillin (to counteract the organism's β-lactamase)

Treatment of gram-negative organisms

Haemophilus influenzae
Klebsiella pneumoniae
Escherichia coli
Pseudomonas aeruginosa
Moraxella catarrhalis

Treatment of atypical organisms

Most atypical causes of pneumonia require treatment for 14-21 days.

Chlamydophila pneumoniae - doxycycline
Chlamydophila psittaci - erythromycin
Mycoplasma pneumoniae - erythromycin
Coxiella burnetti - erythromycin
Legionella pneumophila - erythromycin, with rifampicin sometimes added.

People who have difficulty breathing due to pneumonia may require extra oxygen. An extremely sick individual may require artificial ventilation and intensive care as life-saving measures while his or her immune system fights off the infectious cause with the help of antibiotics and other drugs.

References

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 ==Pathophysiology==
-Bacteria typically enter the lung with inhalation, though they can reach the lung through the bloodstream if other parts of the body are infected. Often, bacteria live in parts of the [[upper respiratory tract]] and are continually being inhaled into the alveoli. Once inside the alveoli, [[bacteria]] travel into the spaces between the cells and also between adjacent alveoli through connecting pores. This invasion triggers the [[immune system]] to respond by sending white blood cells responsible for attacking microorganisms ([[neutrophil]]s) to the lungs. The neutrophils [[phagocytosis|engulf]] and kill the offending organisms but also release cytokines which result in a general activation of the immune system. This results in the fever, chills, and fatigue common in bacterial and fungal pneumonia. The neutrophils, bacteria, and fluid leaked from surrounding blood vessels fill the alveoli and result in impaired oxygen transportation.
-[[Image:Streptococcus pneumoniae.jpg|200px|thumb|The bacterium '''''[[Streptococcus pneumoniae]]''''', a common cause of pneumonia, photographed through an[[electron microscope]].]]
-Bacteria often travel from the lung into the blood stream and can result in serious illness such as [[septic shock]], in which there is low blood pressure leading to damage in multiple parts of the body including the [[brain]], [[kidney]], and [[heart]]. They can also travel to the area between the lungs and the chest wall, called the [[pleural cavity]].
 ==Treatment==