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Pneumonia - Highlights

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of pneumonia.

Highlights:

Prognosis

Men with community-acquired pneumonia tend to fare worse than women. Men are 30% more likely than women to die from the condition, even if the severity of the illness is the same. Researchers say there may be some genetic reason for the disparity.
Pneumonia that is acquired in any health care setting (including the hospital) is more dangerous than pneumonia acquired in the community. Health care-associated pneumonia has a mortality rate of almost 18%, compared to a mortality of just over 6% in community-acquired pneumonia.

Risks

Long-term use of corticosteroid inhalers may increase the risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD) by as much as 70%.

Medications

Even when administered alone, the quinolone antibiotic moxifloxacin (Avelox) is as effective as a combination of two intravenous antibiotics -- ceftriaxone and levofloxacin -- for treating moderate-to-severe community-acquired pneumonia.

Prevention

Some observational studies have found that the flu shot can reduce hospitalizations in the elderly by 30 to 50%. New research challenges that idea, and finds that vaccination only reduces pneumonia rates by 8% during flu season. Yet experts say the flu shot should still be recommended for seniors.
The pneumococcal vaccine (Prevnar or PCV7) cut the rate at which infants are hospitalized for pneumonia by more than 30% from 1997-1999 to 2006.

Resources

www.lungusa.org -- American Lung Association
www3.niaid.nih.gov -- National Institute of Allergy and Infectious Diseases
www.cdc.gov -- Centers for Disease Control and Prevention

References

American Academy of Pediatrics Committee on Infectious Diseases. Recommended immunization schedules for children and adolescents -- United States, 2008. Pediatrics. 2008;121:219-220.

Barr CE, Schulman K, Iacuzio D, Bradley JS. Effect of oseltamivir on the risk of pneumonia and use of health care services in chidlren with clinically diagnosed influenza. Curr Med Res Opin. 2007;23(3):523-531.

Galobardes B, McCarron P, Jeffreys M, Davey-Smith G. Medical history of respiratory disease in early life relates to morbidity and mortality in adulthood. Thorax. 2008;Epub.

Gleason PP, Shaughnessy AF. STEPS new drug reviews telithromycin (Ketek) for treatment of community-acquired pneumonia. Am Fam Physician. 2007;76.

Grijalva CG, Nuorti JP, Arbogast PG, Martin SW, Edwards KM, Griffin MR. Decline in pneumonia admissions after routine childhood immunisation with pneumococcal conjugate vaccine in the USA: a time-series analysis. Lancet. 2007;369:1179-1186.

Grijalva CG, et al. Pneumonia hospitalizations among young children before and after introduction of pneumococcal conjugate vaccine -- United States, 1997 - 2006. MMWR. 2009;58:1-4.

Huss A, Scott P, Stuck AE, Trotter C, Egger M. Efficacy of pneumococcal vaccination in adults: a meta-analysis. CMAJ. 2009;180:48-58.

Jackson M, Nelson JC, Weiss NS, Neuzil KM, Barlow W, Jackson LA. Influenza vaccination and risk of community-acquired pneumonia in immunocompetent elderly people: A population-based, nested case-control study. Lancet. 2008;372:352-354.

Johnstone J, Marrie TJ, Eurich DT, Majumdar SR. Effect of pneumococcal vaccine in hospitalized adults with community-acquired pneumonia. Arch Intern Med. 2007;167:1938-1943.

Knol W, van Marum RJ, Jansen PA, Souverein PC, Schobben AF, Egberts AC. Antipsychotic drug use and risk of pneumonia in elderly people. J Am Geriatr Soc. 2008;56:661-666.

Kollef MH, Afessa B, Anzueto A, Veremakis C, Kerr KM, Margolis BD, et al. Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: The NASCENT randomized trial. JAMA. 2008;300:805-813.

Lee TA, Weaver FM, Weiss KB. Impact of pneumococcal vaccination on pneumonia rates in patients with COPD and asthma. J Gen Intern Med. 2007;22(1):62-67.

Li JZ, Winston LG, Moore DH, Bent S. Efficacy of short-course antibiotic regimens for community-acquired pneumonia: a meta-analysis. Am J Med. 2007;120:783-790.

Limper AH. Overview of Pneumonia. In: Goldman L, Ausiello D. Goldman: Cecil Medicine. Philadelphia, Pa: Saunders; 2007:chap 97.

Lutfiyya MN, Henley E, Chang LF. Diagnosis and treatment of community-acquired pneumonia. Am Fam Physician. 2006;73:442-450.

Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27-S72.

Meissner HC, Long SS. American Academy of Pediatrics Committee on Infectious Diseases and Committee on Fetus and Newborn. Revised indications for the use of palivizumab and respiratory syncytial virus immune globulin intravenous for the prevention of respiratory syncytial virus infections. Pediatrics. 2003;112:1447-1452.

Muller B, Harbath S, Stolz D, et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis. 2007;7:10.

Neuman MI, Willett WC, Curhan GC. Vitamin and micronutrient intake and the risk of community-acquired pneumonia in US women. Am J Med. 2007;120:330-336.

Nisar N, Guleria R, Kuman S, Chand Chawla T, Ranjan Biswas N. Mycoplasma pneumoniae and its role in asthma. Postgrad Med J. 2007;83:100-104.

Reade MC, Yende S, DAngelo G, Milbrandt EB, Kellum JA, Bamato AE, et al. Sex disparities in treatment and outcome of community-acquired pneumonia. Am J Respir Crit Care Med. 2008;177:A770.

Sing S, Amin AV, Loke YK. Long-term use of inhaled corticosteroids and the risk of pneumonia in chronic obstructive pulmonary disease: A meta-analysis. Arch Intern Med. 2009;169:219-229.

Spaude KA, Abrutyn E, Kirchner C, Kim A, Daley J, Fisman DN. Influenza vaccination and risk of mortality among adults hospitalized with community-acquired pneumonia. Arch Intern Med 2007;167(1):53-59.

Venditti M, Falcone M, Corrao S, Licata G, Serra P. Outcomes of patients hospitalized with community-acquired, health-care associated, and hospital-acquired pneumonia. Ann Intern Med. 2009;150:19-26.

Reviewed last on: 3/29/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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