From the Guidelines
Inpatient admission for pneumonia is recommended for patients who meet certain severity criteria, including a CURB-65 score ≥2 or Pneumonia Severity Index (PSI) class IV-V, as these criteria are associated with a higher risk of complications and death 1. The criteria for inpatient admission for pneumonia include:
- Hypoxemia (oxygen saturation <90% or PaO2 <60 mmHg)
- Hemodynamic instability (systolic blood pressure <90 mmHg or requiring vasopressors)
- Respiratory distress (respiratory rate >30 breaths/minute)
- Altered mental status
- Multilobar infiltrates on imaging
- Severe laboratory abnormalities (BUN >20 mg/dL, WBC <4,000 or >20,000 cells/μL, platelets <100,000/μL) Comorbidities that may warrant admission include:
- Immunosuppression
- Chronic lung disease
- Heart failure
- Renal or liver disease
- Inability to take oral medications Social factors like inadequate home support, inability to perform self-care, or medication non-adherence may also necessitate admission 1. It is essential to note that the Pneumonia Severity Index (PSI) and the British Thoracic Society CURB-65 score are useful tools in determining which patients may safely be treated at home and which patients require hospitalization 1. The decision to admit a patient with pneumonia to the hospital should be based on the presence of severity criteria, comorbidities, and social factors that increase the risk of complications and death, as identified by the most recent and highest quality studies 1.
From the Research
Criteria for Inpatient Admission for Pneumonia
The decision to admit a patient with pneumonia to the hospital is based on several factors, including the severity of the disease, the presence of comorbidities, and the patient's ability to manage their condition at home. Some of the key criteria for inpatient admission for pneumonia include:
- Severity of symptoms, such as high fever, difficulty breathing, and chest pain 2, 3
- Presence of comorbidities, such as chronic obstructive pulmonary disease (COPD), heart disease, or diabetes 2, 3
- Need for oxygen therapy or mechanical ventilation 2, 3
- Presence of complications, such as sepsis or acute respiratory distress syndrome (ARDS) 3
- Inability to manage the condition at home, due to lack of support or inability to take medications as directed 4, 5
Antibiotic Treatment for Pneumonia
The choice of antibiotic treatment for pneumonia depends on the severity of the disease, the presence of comorbidities, and the suspected or confirmed cause of the infection. Some of the key considerations for antibiotic treatment include:
- Use of beta-lactam antibiotics, such as ceftriaxone or cefotaxime, for patients with severe community-acquired pneumonia 2, 4
- Use of fluoroquinolone antibiotics, such as levofloxacin or moxifloxacin, for patients with severe community-acquired pneumonia or those who are allergic to beta-lactam antibiotics 2, 4
- Use of combination therapy, such as beta-lactam plus macrolide or fluoroquinolone, for patients with severe community-acquired pneumonia or those who are at high risk for complications 2, 4, 5, 6
Comparison of Antibiotic Regimens
Several studies have compared the effectiveness of different antibiotic regimens for the treatment of pneumonia. Some of the key findings include:
- No significant difference in 30-day readmissions between patients treated with fluoroquinolone monotherapy and those treated with beta-lactam plus macrolide combination therapy 5
- No significant difference in 30-day mortality between patients treated with beta-lactam plus fluoroquinolone and those treated with beta-lactam plus macrolide 6
- Increased length of stay associated with the use of beta-lactam plus fluoroquinolone compared to beta-lactam plus macrolide 6