Clinical Pharmacology · MU Sofia

25. Rational drug prescribing in patients with pneumonia.

Covers rational antibiotic choice for pneumonia, starting with the setting (community or hospital acquired) and the likely pathogens in each. It explains severity grading with the CURB-65 score, including its mortality and management table, and mentions CRB-65 and the Pneumonia Severity Index as alternatives. A second table sets out empirical regimens by setting, followed by duration and hospital-acquired and ventilator-associated pneumonia options.

Inside: 3 sections · 2 tables · 16 flashcards · 2 min

Topic 25 of 30 in the MU Sofia syllabus for Clinical Pharmacology (Medicine, Year 5). The free AceMed note covers it in 3 sections, about 237 words (2 min of reading), with 16 flashcards.

In this note

  1. Introduction
  2. Community-acquired pneumonia (CAP)
  3. Hospital-acquired and ventilator-associated pneumonia

Introduction

Pneumonia is a leading infectious cause of death. Rational treatment depends on the setting (community or hospital acquired), the severity and local resistance. The cause stays unknown in up to 60% of cases, so treatment is mostly empirical.

Community-acquired pneumonia (CAP)

Pathogens

  • Streptococcus pneumoniae (most common), Haemophilus influenzae, Moraxella catarrhalis.
  • Atypical (≈ 20–25%): Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella; viruses (influenza, SARS-CoV-2).
  • Staphylococcus aureus (after influenza), Klebsiella and Gram-negatives (alcoholics, aspiration, COPD).

Assessing severity: CURB-65

One point each for: Confusion, Urea > 7 mmol/L, Respiratory rate ≥ 30/min, BP systolic < 90 or diastolic ≤ 60 mmHg, age ≥ 65.

CRB-65 (without urea) is used in general practice; the Pneumonia Severity Index (PSI, classes I–V) is an alternative.

Empirical treatment (in line with the Bulgarian guidelines)

Duration usually 5–7 days if stable; switch from IV to oral once afebrile and clinically stable. Cochrane reviews find no clear difference in efficacy between the main antibiotic classes in outpatients, so choose by resistance, safety and cost.

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