Pneumonia

There are several components to the successful treatment of pneumonia. The first step is to decide the most appropriate site of care—home, hospital ward, hospital intensive care unit, and, for those who reside in a nursing home, either the nursing home or a hospital. The severity of the pneumonia and or the severity of the comorbid illnesses drive the decision as to the care site.

Patients with pneumonia generally prefer to be treated at home provided they can be assured they are not going to die. In many instances it is obvious that a patient is so sick that he or she should be treated in hospital. There is a pneumonia severity of illness scoring system that can be used to help in the decision as to the site of treatment (Fine et al.). The single best indication of severe pneumonia in an adult (who does not have pre-existing lung disease) is a respiratory rate (counted for one minute) of thirty-two breaths per minute or higher. The second step is deciding what is the most appropriate antibiotic. A number of effective antibiotics are available for the treatment of pneumonia (Naughton et al.; Bartlett et al.). Once the pneumonia is improving in elderly persons a functional and mental Chest radiograph of an elderly person with pneumonia due to Streptococcus pneumoniae. Almost all of the right lung is involved (white area). (Courtesy of the author.) assessment should be carried out. The results of these studies guide the planning of discharge.

The final step is to arrange a follow-up chest X-ray and visit. Two percent of all persons presenting with pneumonia will have pneumonia as the first manifestation of cancer of the lung—the pneumonia is distal to an obstructed bronchus. If the pneumonia has not cleared on the sixth week follow-up chest X-ray, additional studies such as bronchoscopy may be required.