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In medicine, prevention is one of the management options for controlling diseases. In the case of pneumonia, the pneumococcal conjugate vaccine (PCV 13) is endorsed for adults who are 65 years old and above, children less than two years old, and babies (John Hopkins Medicine, n.d.). Moreover, the vaccine is indicated for people aged between 2 to 64 years old who are highly susceptible to pneumonia infections because of specific medical issues. According to Grief and Loza (2018), PCV 13 has resulted in a 46% reduction of community-acquired pneumonia cases, and the protection lasts for four years. The pneumococcal polysaccharide vaccine (Pneumovax 23) is specified for cigarette smokers between 19 and 64 years, adults above 64 years old, and people between 2 and 64 years old with medical conditions.
Bacteria cause most pneumonia infections, and they are managed using antibiotics. Empirical therapy should be the best option for treating pneumonia and should be chosen depending on the etiology and efficacy (Mantero et al., 2017). The prevalence of antibiotics differs among different classes of patients, including inpatients, outpatients, and intensive care unit patients. There is a need for starting early treatment using antibiotics as it helps to reduce 30-day mortality. Antibiotics are administered via the oral route for outpatients, while the endo-venous route is preferred for inpatients until they gain clinical stability, after which oral administration is used. Clinical stability is determined by monitoring respiratory rate, fever, hemodynamic parameters, and inflammatory biomarkers.
Macrolides and doxycyclines should be used in previously healthy patients who lack risk factors for resistant Staphylococcus pneumonia. Examples of these drugs are erythromycin, azithromycin, and clarithromycin. Respiratory fluoroquinolones such as moxifloxacin and levofloxacin are indicated in cases of comorbidities such as diabetes; chronic renal, heart, liver, or lung disease; and compromised immune system. They are also used in cases of resistant Staphylococcus pneumonia, or where patients have used antibiotics within the last three months (Mantero et al., 2017). Moreover, combined therapy of macrolides and beta-lactam antibiotics is directed. High doses of cefuroxime, ceftriaxone, cefpodoxime, amoxicillin, or amoxicillin-clavulanate are used in this treatment. Patients who are allergic to penicillin are managed using respiratory fluoroquinolone. The inpatients who are not in the intensive care unit are treated using either respiratory fluoroquinolones or beta-lactams and macrolides. For intensive care patients, beta-lactams and azithromycin, and beta-lactams and fluoroquinolones are used.
Adequate antimicrobial therapy has positive outcomes; however, it is not sufficient in some cases. For instance, even with sufficient antibiotic treatment, patients with two or more of the following risk factors, arterial blood with a pH of less than 7.35, hypoalbuminemia, high urea levels, needing hospitalization, have a higher probability of 30-day mortality (Mantero et al., 2017). Such patients should be identified early and provided with supportive therapy for better management of their health. The main complication that requires supportive treatment is respiratory failure. There are several non-invasive respiratory support options. Examples include high flow nasal cannula oxygen therapy, non-invasive therapy, and Helmet Continuous Positive Airway Pressure.
Despite antibiotics being the cornerstone of pneumonia treatment, resistance limits their use. For instance, in pneumococcal pneumonia, a monotherapy using beta-lactams will not manage the infection even though the bacteria are susceptible. Staphylococcus pneumoniae has a 20% to 40% resistance against macrolides, and the resistance is still on the rise (Nayar et al., 2019). As bacteria develop resistance against antimicrobials, it may become difficult to manage them in the future. Therefore, there is a need to use the correct antibiotics and dosages to avoid increased resistance cases.
References
Grief, S. N., & Loza, J. K. (2018). Guidelines for the evaluation and treatment of pneumonia.Primary Care: Clinics in Office Practice, 45(3), 485-503. Web.
John Hopkins Medicine. (n.d.). Pneumonia. Web.
Mantero, M., Tarsia, P., Gramegna, A., Henchi, S., Vanoni, N., & Di Pasquale, M. (2017). Antibiotic therapy, supportive treatment and management of immunomodulation-inflammation response in community acquired pneumonia: Review of recommendations.Multidisciplinary Respiratory Medicine, 12(1), 1-9. Web.
Nayar, S., Hasan, A., Waghray, P., Ramananthan, S., Ahdal, J., & Jain, R. (2019). Management of community-acquired bacterial pneumonia in adults: Limitations of current antibiotics and future therapies.Lung India: Official Organ of Indian Chest Society, 36(6), 525-533. Web.
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