Bacterial pneumonia primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arooj Naz

Overview

The goal of Primary prevention is to prevent the occurrence of an illness or a disease before it ever occurs. In the case of bacterial pneumonia, primary prevention can be achieved by the administration of vaccination as well as attempting to control underlying comorbidities that may predispose an individual to pneumonia. When certain conditions are present, it may also be helpful to treat with prophylactic antibiotics. Educating the public as well as identifying those most susceptible to infection can help reduce the risk of pneumonia.

Vaccinations

-Routinely administered vaccines include:

• Pneumococcus (Intramuscular Conjugate or polysaccharide vaccine)
• Annual vaccine against H. influenza(Intramusuclar killed vaccine)

Pneumococcus Vaccine Indications

	Advantages	Disadvanatges	Indications
PCV13 (Conjugate vaccine)	immune response is more effective, especially in the elderly and children under the age of 2 long-lasting immunity due to the formation of memory B cells mucosal immunity (promotes herd immunity)	protects against fewer serotypes	infants and childhood routine vaccines (children younger than 2 years) all adults aged 65 years or older
PPSV23 (Polysaccharide vaccine)	protects against a wider range of serotypes	antibodies decline over 5 years does not produce an immunological response in children under the age of 2	recommended for all adults over the age of 65 recommended for ages 19-64 with certain medical conditions: Chronic heart, lung, or liver diseases Diabetics Current smokers Alcoholics
PCV13 + PPSV23			All patients above the age of 65 Very high-risk patients below the age of 65 Sickle cell disease and asplenia Immunocompromised patient Chronic kidney disease CSF fluid leaks

Controlling Underlying Comorbidities and Patient Education

• Comorbidities significantly increase the risk of bacterial pneumonia and should be controlled to aid in prevention. These include:
  • Strict blood glucose and blood pressure control
  • Seeking treatment for chronic lung conditions such as COPD and Asthma
• Smoking Cessation
• Abstaining from alcohol overuse
• Maintaining good dental hygiene
• The elderly and immunocompromised should consider medical assistance if they develop worrisome symptoms such as a fever accompanied by dyspnea and rigors

Conditions Requiring Prophylaxis

For children that have asplenia (including functional asplenia, as seen in sickle-cell disease), daily antimicrobial prophylaxis with oral penicillin V in addition to immunization is recommended. For patients with a history of splenectomy, antibiotics should be continued for a period of 1 year after the surgery.

References

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