Prevention Of Pneumonia

Preventive measures for pneumonia can be classified in two ways. The more common method of prevention consists of vaccinations directed toward influenza virus and pneumococci which work by enhancing host resistance once the organism is encoun-

Table 8

Empiric Therapy Recommendations for HAP

Empiric Scenario

Recommendations

Rationale

Mild to moderate HAP without risk factors OR

Severe HAP without risk factors and early onset (21,22)

Mild to moderate HAP with PCN allergy

Mild to moderate HAP with risk of infection with anaerobes

HAP with MRSA likely

HAP with Legionella infection likely

Severe HAP with risk factors or late onset (> 5 d after hospitalization)

• Second-generation cephalosporin, OR

• Nonpseudomonal third-

generation cephalosporin, OR

• Fluoroquinolone OR

• Clindamycin and aztreonam

• Add clindamycin to above OR

• Add vancomycin

• Add erythromycin or rifampin

• (Aminoglycoside or ciprofloxacin) + (antipseudomonal PCN or p-lactam/p-lactamase inhibitor or ceftazidime or cefoperazone or imipenam or aztreonam)

High frequency of H.

influenzae, S. pneumoniae, or S. aureus infection

Good coverage against H. influenzae, S. pneumoniae, or S. aureus infection

Provide better coverage against anaerobes

Reliable and effective treatment of MRSA

PCN = penicillin

MRSA = methicillin-resistant Staphylococcus aureus tered. Influenza vaccines are recommended for all individuals over the age of 65: for subjects at risk for adverse outcomes, including any immunocompromised state, such as heart disease, lung disease, malignancy, or diabetes: and for health care workers exposed to the virus. This vaccination works both by reducing the incidence of influenza pneumonia and by decreasing secondary bacterial pneumonia from superinfection. The currently available 23-valent pneumococcal vaccine is active against almost 90% of serotypes causing disease and some related serotypes. The increasing prevalence of antibiotic resistance among pneumococcal isolates makes immunization of high-risk individuals a particularly important intervention.

The second method of prevention relates only to hospital-acquired pneumonia and is directed at decreasing the chance of an organism reaching a susceptible host environment (23,24). This includes strategies to maintain gastric acidity and prevent aspiration, control spread of infection by washing hands properly, using gloves and face masks, and utilizing negative pressure isolation rooms.

Coping with Asthma

Coping with Asthma

If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

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