Management of Bacterial Pneumonia

Indications of hospitalization is:
1. Patients with basic diseases
2. Patients with complications.

General management.
1. Correction of underlying abnormalities (underlying disease)
2. Bedrest
3. Symptomatic medications, administered only if necessary, such as:

3 x 500 mg Paracetamol (in hyperpyrexia)
Morphine 10 mg s.c. (If there is pain severe).

4. Maintain fluid and electrolyte balance with the help of intravenous fluids, 5% dextrose, normal saline or Ringer's lactate.

5. Selection of anti-infective drugs.
Selection of antimicrobial drugs, should be based on sensitivity tests and sensitivity, but due to time and facilities greatly affect the success of this test, then giving more medicine based on empirical, as below:

Special Treatment:
1. Pneumococcal pneumonia,

Basic disease: elderly, Chronic Obstructive Pulmonary Disease (COPD), CHD, diabetes mellitus, alcoholism, post-influenza.
Clinical features: sudden illness, high fever, chills, pleuritic pain, cough productive with phlegm such as iron rust, herpes labialis.
Physical diagnostics: signs of consolidation.
Chest X photo: visible presence consolidated picture.
Laboratory:
- Blood banks: lekositosis 15,000 - 40.000/ml.
- Sputum: gram positive cocci which are lancet-shaped.
Treatment:
a. Antibiotics options:
Penicillin G from 0.6 to 1.2 million units i.m. every 12 hours, for 50-10 days.
b. Antibiotics alternatives:
Erythromycin 500 mg orally every 8 hours for 5-10 days or Tetracycline 500 mg orally every 8 hours for 5-10 days.

2. Staphylococcal pneumonia.

Basic disease: post-influenza, diabetes mellitus, malignancy, advanced age, use of drugs.
Clinical features: sudden onset of illness accompanied by high fever, chills, pleuritic pain and shortness of breath accompanied by cough productive with purulent sputum (with blood).
Physical diagnostics: look for signs of consolidation in one lobe or
several segments, and quickly arise necrosis, abscess and
pneumatokel.
Chest X photo: a picture of consolidation in one lobe or the
some segments.
Laboratory:
- Blood banks: leucocytes 15,000 - 35.000/ml
- Sputum: gram-positive cocci found that gather.
Treatment:
a. Antibiotic choice: cloxacillin 250-500 mg iv given every 6 hours for 5-10 days.
b. Alternative antibiotics: Cephalexin / Sefazolin 0.5 to 1 gram, 3 times a day, for 50-10 days.

3. Pneumonia klebsiela.

Basic disease: Chronic Obstructive Pulmonary Disease (COPD), alcoholics, elderly, diabetes mellitus
Clinical symptoms: sudden illness, high fever, chills, pleuritic pain, shortness of breath, productive cough with phlegm like jelly (currant jelly)
Physical diagnostics: according to the signs of consolidation, chest looks
more convex.
Chest X photo: picture looks consolidation with an enlarged volume
so that the fissure becomes convex (bulging).
Laboratory:
- Blood banks: leucocytes 15,000 - 40.000/ml.
- Sputum: gram-negative bacilli appear in the form of fat.
Treatment:
a. Antibiotic choice: Ampicillin 1000 mg i.v. given every 6 hours, plus Gentamicin 60-80 mg every 8 hours, for 50-10 days.
b. Alternative antibiotics: Cefotaxime 1 g i.v. every 6 hours for 5-10 days.