From the Guidelines
Admission to the hospital is recommended for patients with pneumonia who exhibit severe symptoms, such as respiratory rate greater than 30 breaths per minute, oxygen saturation less than 90% on room air, or requirement for supplemental oxygen 1.
Indications for Hospital Admission
The following are indications for hospital admission in patients with pneumonia:
- Severe symptoms, such as respiratory rate greater than 30 breaths per minute, or oxygen saturation less than 90% on room air 1
- Inability to tolerate oral antibiotics, such as azithromycin 500mg daily for 5 days or ceftriaxone 1g every 24 hours for 5-7 days 1
- Underlying comorbidities, such as congestive heart failure or chronic obstructive pulmonary disease 1
- Hemodynamic instability, or a CURB-65 score of 2 or greater 1
- Requirement for close monitoring and supportive care, including intravenous fluids and oxygen therapy 1, 2
Additional Considerations
Other factors that may necessitate hospital admission include:
- Complications of the pneumonia itself, such as pleural effusion or shock 1
- Exacerbation of underlying diseases, such as obstructive lung disease or congestive heart failure 1
- Inability to safely and reliably take oral medication, or lack of outpatient support resources 1
- Presence of rare illnesses, such as neuromuscular or sickle cell disease, which may require hospitalization but not affect the PSI score 1
From the FDA Drug Label
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).
The indications for hospital admission in a patient with pneumonia include:
- Moderate to severe illness
- Risk factors such as:
- Cystic fibrosis
- Nosocomially acquired infections
- Known or suspected bacteremia
- Elderly or debilitated patients
- Significant underlying health problems (including immunodeficiency or functional asplenia) 3
From the Research
Indications for Hospital Admission in Pneumonia
The decision to admit a patient with pneumonia to the hospital is based on several factors, including:
- Severity of symptoms, such as respiratory rate greater than 30/min 4
- Presence of comorbidities, such as chronic obstructive pulmonary disease (COPD) 5, 6
- Laboratory abnormalities, such as low serum albumin value, abnormal liver function, and elevated serum creatinine 4, 6
- Need for oxygen therapy, with oxygen saturations less than 92% being associated with major adverse events 7
- Presence of clinical signs of septicaemia, such as fever and low blood pressure 4, 6
Specific Criteria for ICU Admission
Patients with pneumonia may require admission to the intensive care unit (ICU) if they have:
- Respiratory failure requiring intubation and ventilation 5
- Severe pneumonia involving more than two lobes 4
- Partial arterial oxygen pressure less than 8 kPa 4
- Clinical signs of septicaemia, such as fever and low blood pressure 4
Scoring Systems for Pneumonia Severity
Several scoring systems, such as the Pneumonia Severity Index (PSI) and CURB-65, can be used to assess the severity of pneumonia and guide decisions about hospital admission 5, 7, 8. However, these scoring systems may not always accurately predict the need for hospital admission, and clinical judgment should also be used to guide decision-making 5.