From the Guidelines
Pneumonia treatment in the pre-hospital setting should prioritize oxygen administration and supportive care, as antibiotics are rarely administered pre-hospital unless protocols specifically allow it. Pneumonia in the pre-hospital setting presents with symptoms including cough, fever, shortness of breath, chest pain, rapid breathing, and decreased oxygen levels. First responders should focus on assessing vital signs, oxygen saturation, and respiratory effort.
Key Considerations
- Assessing vital signs and oxygen saturation is crucial in the pre-hospital setting to determine the severity of pneumonia.
- Oxygen administration is critical to maintain saturation above 94% (or 88-92% in COPD patients), typically via nasal cannula at 2-6 L/min or non-rebreather mask at 10-15 L/min for severe cases.
- Positioning the patient upright can help ease breathing.
- For severe respiratory distress, consider CPAP if available and appropriate.
- Intravenous access should be established for fluid administration if the patient shows signs of dehydration or shock.
Treatment Approach
While antibiotics are the definitive treatment for pneumonia, they're rarely administered pre-hospital unless protocols specifically allow it. According to guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents 1, severe pneumonia requires intensive care with an IV beta-lactam plus either IV azithromycin or an IV respiratory fluoroquinolone. However, this is typically not feasible in the pre-hospital setting.
Supportive Care
- Antipyretics like acetaminophen (1000mg) or ibuprofen (400-600mg) can be given for high fever if permitted by protocols.
- Bronchodilators such as albuterol (2.5mg nebulized) may help if wheezing is present, especially in patients with underlying lung disease.
Ongoing Care
Throughout transport, continuously monitor vital signs, oxygen levels, and mental status, as pneumonia can rapidly deteriorate into respiratory failure requiring more aggressive intervention. Early notification to the receiving facility about the patient's condition allows for prompt continuation of care upon arrival.
From the FDA Drug Label
If an allergic reaction occurs, the drug should be discontinued and appropriate therapy should be instituted. Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, elderly or debilitated patients, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia).
- Pneumonia presentation and treatment pre hospital: The provided drug labels do not directly address pneumonia presentation and treatment in a pre-hospital setting.
- Treatment of pneumonia: Azithromycin has only been shown to be safe and effective in the treatment of community-acquired pneumonia due to certain pathogens in patients appropriate for oral therapy 2.
- Pre hospital treatment: There is no information in the provided drug labels that directly supports the answer to this question. The FDA drug label does not answer the question.
From the Research
Pneumonia Presentation
- Pneumonia is a common cause of respiratory infection, accounting for more than 800,000 hospitalizations in the United States annually 3
- Presenting symptoms of pneumonia are typically cough, pleuritic chest pain, fever, fatigue, and loss of appetite 3
- Children and the elderly have different presenting features of pneumonia, which include headache, nausea, abdominal pain, and absence of one or more of the prototypical symptoms 3
Pneumonia Treatment
- The optimal antibiotic regimen for treating severe community-acquired pneumonia is crucial for improving patient outcomes 4
- β-lactam antibiotics plus macrolides may be the optimal treatment for severe community-acquired pneumonia 4
- Monotherapy with oral Levofloxacin was as effective as treatment with Ceftriaxone plus Azithromycin combination in patients with community-acquired pneumonia who required hospitalization 5
- Azithromycin was associated with a lower mortality and more hospital free days compared to doxycycline in combination with beta-lactams in hospitalized patients with community-acquired pneumonia 6
Pre-Hospital Treatment
- There is limited information available on pre-hospital treatment of pneumonia, but knowledge of local bacterial pathogens and their antibiotic susceptibility and resistance profiles is key for effective pharmacologic selection and treatment of pneumonia 3
- Vaccinations for influenza and pneumococcal infections are becoming widely available for vulnerable groups of people, which will help to reduce the incidence of pneumonia 7
Antibiotic Regimens
- β-lactam antibiotics plus macrolides was ranked as the most effective treatment for severe community-acquired pneumonia, significantly reducing overall mortality compared to β-lactam antibiotics alone and β-lactam antibiotics plus fluoroquinolones 4
- Azithromycin or doxycycline in combination with a beta-lactam can be used to treat community-acquired pneumonia, but azithromycin was associated with a lower mortality and more hospital free days compared to doxycycline 6