pneumonia

23-valent pneumococcal capsular polysaccharide vaccine

PMID (1):

41114997

MeSH

13-valent pneumococcal vaccine

spleen

COVID-19

Streptococcus pneumoniae

Influenza

Diagnosis and Treatment of Community-Acquired Pneumonia (CAP)

Pneumococcal Infections

Hypersensitivity

Herpes Zoster

Information for patients about pneumococcal immunizations. James W. Mold, MD, MPH

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What Is the Pneumococcal Pneumonia Vaccine?
The pneumococcal vaccine protects against infections from a type of bacteria called pneumococcus. Pneumococcus is a common cause of pneumonia (a lung infection), as well as other serious infections. The vaccine prepares your immune system to recognize and fight pneumococcal bacteria. The vaccine is usually given through an injection into the arm. Some versions can also be inhaled. The vaccines do not contain living or dead bacteria. The pneumococcal vaccine does not protect you from other lung infections like the flu (influenza), COVID-19, RSV (respiratory syncytial virus), or other kinds of bacteria that cause pneumonia. It is still important to get your flu shot every year and other vaccines your doctor recommends, even if you already got the pneumococcal vaccine.

What Are Benefits of Pneumococcal Pneumonia Vaccines?
The vaccine substantially lowers your risk of hospitalization or dying from serious pneumococcal infection. Vaccination can reduce the risk of pneumonia-related deaths by almost half.

Why Is There a New Pneumococcal Pneumonia Vaccine, and How Does It Differ From Prior Versions?
There are several types of pneumococcal bacteria that can cause pneumonia. Being vaccinated against one type of pneumococcus may not protect you from other types that could make you sick. Previous pneumococcal pneumonia vaccines like PPSV23 or PCV13 do not protect against all types of the pneumococcal bacteria that cause pneumonia. Newer vaccines were made in 2021 (PCV15 and PCV20) and 2024 (PCV21). These help to prevent infections from types of bacteria not covered by older versions.

What Are the Potential Side Effects?
Side effects are frequent but generally mild. The most common side effect is pain or redness at the site of injection. Less common side effects include fever, feeling tired, muscle ache, and headache. These are less severe than for other vaccines like flu and shingles. These effects can be treated with over-the-counter medications and generally go away within 24 to 48 hours. Life-threatening allergic reactions are extremely rare but possible. Seek immediate medical attention if you experience severe symptoms like difficulty breathing or progressive weakness after vaccination. The pneumonia vaccine cannot cause pneumonia or other bacterial illness.

Who Should Get a New Pneumococcal Pneumonia Vaccine?
All adults 50 years and older who have not been vaccinated should receive one of the new vaccines: PCV21, PCV20, or a sequence of PCV15 followed by PPSV23. People younger than 50 years with certain health problems should also get the new vaccine. These health problems include diabetes; chronic conditions affecting the heart, lungs, liver, or kidneys; current tobacco use or heavy alcohol consumption; a weak immune system from certain health problems or medications; absence or prior removal of the spleen; and a history of spinal fluid leak or a cochlear (inner ear) implant.

Most adults who got either PPSV23 and/or PCV13 should still get a booster with one of the newer vaccines. The different pneumococcal vaccines protect against different types of bacteria. Some types of bacteria are more common in people depending on their age, health, and where they live. Talk to your doctor about which vaccine is best for you.

Author/s:

Jerard Z. Kneifati-Hayek, Michael A. Incze

Diagnosis and Treatment of Community-Acquired Pneumonia (CAP)

Alex Haga — Wed, 08 Jan 2025 14:30:36 +0000

Date Added:

January 8, 2025

Journal/Publication:

JAMA

Publication Date:

September 16, 2024

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

Keywords

MeSH

Diagnosis and Treatment of Community-Acquired Pneumonia (CAP)

A 23 minutes audiotaped interview on diagnosis and management of community acquired pneumonia. James W. Mold, MD, MPH

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Community-acquired pneumonia is associated with approximately 740 000 hospitalizations and 41 000 deaths in the US annually. JAMA Review authors Scott A. Flanders, MD, and Valerie M. Vaughn, MD, MSc, discuss diagnosis and treatment of community-acquired pneumonia with JAMA Deputy Editor Mary McGrae McDermott, MD.

Author/s:

Scott A. Flanders, Valerie M. Vaughn

Diagnosis and Treatment of Community-Acquired Pneumonia (CAP)

Alex Haga — Wed, 18 Sep 2024 17:07:42 +0000

Date Added:

September 18, 2024

Journal/Publication:

JAMA

Publication Date:

September 16, 2024

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

Keywords

CAP

MeSH

Community-Acquired Pneumonia: A Review

An audiotaped summary of the current recommendations for diagnosis and management of patients with community acquired pneumonia. James W. Mold, MD, MPH

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Author/s:

Scott A. Flanders, Valerie M. Vaughn, Mary McGrae McDermott

Community-Acquired Pneumonia: A Review

Alex Haga — Wed, 18 Sep 2024 17:02:31 +0000

Date Added:

September 18, 2024

Journal/Publication:

JAMA

Publication Date:

September 16, 2024

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2024.14796

Keywords

PMID (1):

39283629

MeSH

Respiratory Distress Syndrome

Streptococcus pneumoniae

Ceftriaxone

COVID-19

A review of current thinking regarding the diagnosis and treatment of patients with community acquired pneumonia. James W. Mold, MD, MPH

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Importance: Community-acquired pneumonia (CAP) results in approximately 1.4 million emergency department visits, 740 000 hospitalizations, and 41 000 deaths in the US annually.

Observations: Community-acquired pneumonia can be diagnosed in a patient with 2 or more signs (eg, temperature >38 °C or ≤36 °C; leukocyte count <4000/μL or >10 000/μL) or symptoms (eg, new or increased cough or dyspnea) of pneumonia in conjunction with consistent radiographic findings (eg, air space density) without an alternative explanation. Up to 10% of patients with CAP are hospitalized; of those, up to 1 in 5 require intensive care. Older adults (≥65 years) and those with underlying lung disease, smoking, or immune suppression are at highest risk for CAP and complications of CAP, including sepsis, acute respiratory distress syndrome, and death. Only 38% of patients hospitalized with CAP have a pathogen identified. Of those patients, up to 40% have viruses identified as the likely cause of CAP, with Streptococcus pneumoniae identified in approximately 15% of patients with an identified etiology of the pneumonia. All patients with CAP should be tested for COVID-19 and influenza when these viruses are common in the community because their diagnosis may affect treatment (eg, antiviral therapy) and infection prevention strategies. If test results for influenza and COVID-19 are negative or when the pathogens are not likely etiologies, patients can be treated empirically to cover the most likely bacterial pathogens. When selecting empirical antibacterial therapy, clinicians should consider disease severity and evaluate the likelihood of a bacterial infection-or resistant infection-and risk of harm from overuse of antibacterial drugs. Hospitalized patients without risk factors for resistant bacteria can be treated with β-lactam/macrolide combination therapy, such as ceftriaxone combined with azithromycin, for a minimum of 3 days. Systemic corticosteroid administration within 24 hours of development of severe CAP may reduce 28-day mortality.

Conclusions: Community-acquired pneumonia is common and may result in sepsis, acute respiratory distress syndrome, or death. First-line therapy varies by disease severity and etiology. Hospitalized patients with suspected bacterial CAP and without risk factors for resistant bacteria can be treated with β-lactam/macrolide combination therapy, such as ceftriaxone combined with azithromycin, for a minimum of 3 days.

Author/s:

Valerie M Vaughn, Robert P Dickson, Jennifer K Horowit, Scott A Flanders

Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia: The CAP-IT Randomized Clinical Trial

Bethie Seay — Sun, 07 Nov 2021 05:00:00 +0000

Date Added:

November 7, 2021

Journal/Publication:

JAMA

Publication Date:

November 2, 2021

Issue:

Volume:

326

Pages:

1713-1724

Type:

Clinical Research Results

DOI (1):

10.1001/jama.2021.17843

3 days of standard dose amoxicillin was as effective as 7 days of high-dose amoxicillin for treatment of CAP in children discharged from an ED. In both cases, additional antibiotic treatment was required subsequently in around 12.5% of kids.

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Importance
The optimal dose and duration of oral amoxicillin for children with community-acquired pneumonia (CAP) are unclear.

Objective
To determine whether lower-dose amoxicillin is noninferior to higher dose and whether 3-day treatment is noninferior to 7 days.

Design, Setting, and Participants
Multicenter, randomized, 2 × 2 factorial noninferiority trial enrolling 824 children, aged 6 months and older, with clinically diagnosed CAP, treated with amoxicillin on discharge from emergency departments and inpatient wards of 28 hospitals in the UK and 1 in Ireland between February 2017 and April 2019, with last trial visit on May 21, 2019.

Interventions
Children were randomized 1:1 to receive oral amoxicillin at a lower dose (35-50 mg/kg/d; n = 410) or higher dose (70-90 mg/kg/d; n = 404), for a shorter duration (3 days; n = 413) or a longer duration (7 days; n = 401).

Main Outcomes and Measures
The primary outcome was clinically indicated antibiotic re-treatment for respiratory infection within 28 days after randomization. The noninferiority margin was 8%. Secondary outcomes included severity/duration of 9 parent-reported CAP symptoms, 3 antibiotic-related adverse events, and phenotypic resistance in colonizing Streptococcus pneumoniae isolates.

Results
Of 824 participants randomized into 1 of the 4 groups, 814 received at least 1 dose of trial medication (median [IQR] age, 2.5 years [1.6-2.7]; 421 [52%] males and 393 [48%] females), and the primary outcome was available for 789 (97%). For lower vs higher dose, the primary outcome occurred in 12.6% with lower dose vs 12.4% with higher dose (difference, 0.2% [1-sided 95% CI –∞ to 4.0%]), and in 12.5% with 3-day treatment vs 12.5% with 7-day treatment (difference, 0.1% [1-sided 95% CI –∞ to 3.9]). Both groups demonstrated noninferiority with no significant interaction between dose and duration (P = .63). Of the 14 prespecified secondary end points, the only significant differences were 3-day vs 7-day treatment for cough duration (median 12 days vs 10 days; hazard ratio [HR], 1.2 [95% CI, 1.0 to 1.4]; P = .04) and sleep disturbed by cough (median, 4 days vs 4 days; HR, 1.2 [95% CI, 1.0 to 1.4]; P = .03). Among the subgroup of children with severe CAP, the primary end point occurred in 17.3% of lower-dose recipients vs 13.5% of higher-dose recipients (difference, 3.8% [1-sided 95% CI, –∞ to10%]; P value for interaction = .18) and in 16.0% with 3-day treatment vs 14.8% with 7-day treatment (difference, 1.2% [1-sided 95% CI, –∞ to 7.4%]; P value for interaction = .73).

Conclusions and Relevance
Among children with CAP discharged from an emergency department or hospital ward (within 48 hours), lower-dose outpatient oral amoxicillin was noninferior to higher dose, and 3-day duration was noninferior to 7 days, with regard to need for antibiotic re-treatment. However, disease severity, treatment setting, prior antibiotics received, and acceptability of the noninferiority margin require consideration when interpreting the findings.

Trial Registration
ISRCTN Identifier: ISRCTN76888927

Author/s:

Bielicki, J. A., Stöhr, W., Barratt, S., Dunn, D., Naufal, N., Roland, D., Sturgeon, K., Finn, A., Rodriguez-Ruiz, J. P., Malhotra-Kumar, S., Powell, C., Faust, S. N., Alcock, A. E., Hall, D., Robinson, G., Hawcutt, D. B., Lyttle, M. D., Gibb, D. M., Sharland, M.

Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians

Devin Evans — Wed, 07 Apr 2021 05:00:00 +0000

Date Added:

April 7, 2021

Journal/Publication:

Annals of Internal Medicine

Publication Date:

April 6, 2021

URL:

Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M20-7355

Keywords

Drug Resistance, Microbial

Cellulitis

bacterial infections

Anti-Bacterial Agents

Best practive

PMID (1):

33819054

MeSH

Cellulitis

Bacterial Infections

bronchitis

Antibiotic Choice and Clinical Outcomes in Ambulatory Children with Community-Acquired Pneumonia

anti-bacterial agents

Advice from American College of Physicians regarding how long to treat adult patients with antibiotics for common infections. James W. Mold, MD, MPH

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Description: Antimicrobial overuse is a major health care issue that contributes to antibiotic resistance. Such overuse includes unnecessarily long durations of antibiotic therapy in patients with common bacterial infections, such as acute bronchitis with chronic obstructive pulmonary disease (COPD) exacerbation, community-acquired pneumonia (CAP), urinary tract infections (UTIs), and cellulitis. This article describes best practices for prescribing appropriate and short-duration antibiotic therapy for patients presenting with these infections.

Methods: The authors conducted a narrative literature review of published clinical guidelines, systematic reviews, and individual studies that addressed bronchitis with COPD exacerbations, CAP, UTIs, and cellulitis. This article is based on the best available evidence but was not a formal systematic review. Guidance was prioritized to the highest available level of synthesized evidence.

Best practice advice 1: Clinicians should limit antibiotic treatment duration to 5 days when managing patients with COPD exacerbations and acute uncomplicated bronchitis who have clinical signs of a bacterial infection (presence of increased sputum purulence in addition to increased dyspnea, and/or increased sputum volume).

Best practice advice 2: Clinicians should prescribe antibiotics for community-acquired pneumonia for a minimum of 5 days. Extension of therapy after 5 days of antibiotics should be guided by validated measures of clinical stability, which include resolution of vital sign abnormalities, ability to eat, and normal mentation.

Best practice advice 3: In women with uncomplicated bacterial cystitis, clinicians should prescribe short-course antibiotics with either nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole (TMP-SMZ) for 3 days, or fosfomycin as a single dose. In men and women with uncomplicated pyelonephritis, clinicians should prescribe short-course therapy either with fluoroquinolones (5 to 7 days) or TMP-SMZ (14 days) based on antibiotic susceptibility.

Best practice advice 4: In patients with nonpurulent cellulitis, clinicians should use a 5- to 6-day course of antibiotics active against streptococci, particularly for patients able to self-monitor and who have close follow-up with primary care.

Author/s:

Lee, Rachael A., Centor, Robert M., Humphrey, Linda L., Jokela, Janet A., Andrews, Rebecca, Qaseem, Amir

Antibiotic Choice and Clinical Outcomes in Ambulatory Children with Community-Acquired Pneumonia

Devin Evans — Mon, 12 Oct 2020 05:00:00 +0000

Date Added:

October 12, 2020

Journal/Publication:

The Journal of Pediatrics

Publication Date:

October 9, 2020

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1016/j.jpeds.2020.10.005

Keywords

antibiotic stewardship

outcomes research

macrolides

complex chronic condition

MeSH

macrolides

anti-bacterial agents

Effectiveness of a Mouth Care Program Provided by Nursing Home Staff vs Standard Care on Reducing Pneumonia Incidence: A Cluster Randomized Trial

Based upon this met-analysis and current guidelines, macrolide antibiotics alone (without the addition of narrow- or broad-spectrum antibiotics) are the best treatment for community-acquired pneumonia in children. James W. Mold, MD, MPH

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Objectives

To describe antibiotic prescribing patterns in ambulatory children with community acquired pneumonia, and to assess the relationship between antibiotic selection and clinical outcomes.

Study design

This was a retrospective cohort study of ambulatory Medicaid-enrolled children 0-18 years of age diagnosed with CAP from 2010-2016. The exposure was antibiotic class: narrow-spectrum (aminopenicillins), broad-spectrum (amoxicillin/clavulanate and cephalosporins), macrolide monotherapy, macrolides with narrow-spectrum antibiotics, or macrolides with broad-spectrum antibiotics. The associations between antibiotic selection and the outcomes of subsequent hospitalization and development of severe pneumonia (chest drainage procedure, intensive care admission, mechanical ventilation) were assessed, controlling for measures of illness severity.

Results

Among 252,177 outpatient pneumonia visits, macrolide monotherapy was used in 43.2%, narrow-spectrum antibiotics in 26.1%, and broad-spectrum antibiotics in 24.7%. A total of 1488 children (0.59%) were subsequently hospitalized and 117 (0.05%) developed severe pneumonia. Compared with children receiving narrow-spectrum antibiotics, the odds of subsequent hospitalization were higher in children receiving broad-spectrum antibiotics (aOR=1.34 [95%CI 1.17-1.52]) and lower in children receiving macrolide monotherapy (aOR=0.64 [95%CI 0.55-0.73]) and macrolides with narrow-spectrum antibiotics (aOR=0.62 [95%CI 0.39-0.97]). Children receiving macrolide monotherapy had lower odds of developing severe pneumonia than children receiving narrow-spectrum antibiotics (aOR=0.56, 95%CI 0.33-0.93). However, the absolute risk difference was <0.5% for all analyses.

Conclusions

Macrolides are the most commonly prescribed antibiotic for ambulatory children with CAP. Subsequent hospitalization and severe pneumonia are rare. Future efforts should focus on reducing broad-spectrum and macrolide antibiotic prescribing.

Author/s:

Lipsett, Susan C., Hall, Matthew, Ambroggio, Lilliam, Hersh, Adam L., Shah, Samir S., Brogan, Thomas V., Gerber, Jeffrey S., Williams, Derek J., Grijalva, Carlos G., Blaschke, Anne J., Neuman, Mark I.

Effectiveness of a Mouth Care Program Provided by Nursing Home Staff vs Standard Care on Reducing Pneumonia Incidence: A Cluster Randomized Trial

Brian Desmarais — Mon, 22 Jun 2020 15:39:47 +0000

Date Added:

June 22, 2020

Journal/Publication:

JAMA Network Open

Publisher:

American Medical Association

Publication Date:

June 1, 2020

Issue:

Volume:

URL:

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.1001/jamanetworkopen.2020.4321

Keywords

MeSH

The organisms responsible for pneumonia live in the mouth. Technically, nearly all pneumonias are due to aspiration. At least one RCT in Japan showed that excellent oral hygiene (by dental hygienists) in NHs can reduce the incidence of pneumonia. This study showed that enhanced oral hygiene performed by nurses reduced pneumonia episodes for the first year, and then the effect waned. James W. Mold, MD, MPH

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Abstract

Importance: Pneumonia affects more than 250 000 nursing home (NH) residents annually. A strategy to reduce pneumonia is to provide daily mouth care, especially to residents with dementia.

Objective: To evaluate the effectiveness of Mouth Care Without a Battle, a program that increases staff knowledge and attitudes regarding oral hygiene, changes mouth care, and improves oral hygiene, in reducing the incidence of pneumonia among NH residents.

Design, setting, and participants: This pragmatic cluster randomized trial observing 2152 NH residents for up to 2 years was conducted from September 2014 to May 2017. Data collectors were masked to study group. The study included 14 NHs from regions of North Carolina that evidenced proportionately high rehospitalization rates for pneumonia and long-term care residents. Nursing homes were pair matched and randomly assigned to intervention or control groups.

Intervention: Mouth Care Without a Battle is a standardized program that teaches that mouth care is health care, provides instruction on individualized techniques and products for mouth care, and trains caregivers to provide care to residents who are resistant and in special situations. The control condition was standard mouth care.

Main outcomes and measures: Pneumonia incidence (primary) and hospitalization and mortality (secondary), obtained from medical records.

Results: Overall, the study enrolled 2152 residents (mean [SD] age, 79.4 [12.4] years; 1281 [66.2%] women; 1180 [62.2%] white residents). Participants included 1219 residents (56.6%) in 7 intervention NHs and 933 residents (43.4%) in 7 control NHs. During the 2-year study period, the incidence rate of pneumonia per 1000 resident-days was 0.67 and 0.72 in the intervention and control NHs, respectively. Neither the primary (unadjusted) nor secondary (covariate-adjusted) analyses found a significant reduction in pneumonia due to Mouth Care Without a Battle during 2 years (unadjusted incidence rate ratio, 0.90; upper bound of 1-sided 95% CI, 1.24; P = .27; adjusted incidence rate ratio, 0.92; upper bound of 1-sided 95% CI, 1.27; P = .30). In the second year, the rate of pneumonia was nonsignificantly higher in intervention NHs. Adjusted post hoc analyses limited to the first year found a significant reduction in pneumonia incidence in intervention NHs (IRR, 0.69; upper bound of 1-sided 95% CI, 0.94; P = .03).

Conclusions and relevance: This matched-pairs cluster randomized trial of a mouth care program compared with standard care was not effective in reducing pneumonia incidence at 2 years, although reduction was found during the first year. The lack of significant results in the second year may be associated with sustainability. Improving mouth care in US NHs may require the presence and support of dedicated oral care aides.

Author/s:

Zimmerman, S., Sloane, P.D., Ward, K., Wretman, C.J., Stearns, S.C., Poole, P., Preisser, J.S.

Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices

John Bayhi — Fri, 22 Nov 2019 15:07:10 +0000

Date Added:

November 22, 2019

Journal/Publication:

Morbidity and Mortality Weekly Report

Publisher:

Centers for Disease Control and Prevention

Publication Date:

November 22, 2019

Issue:

Volume:

Pages:

1069-1075

URL:

Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices

Type:

Public Health Announcements

Format:

Article

DOI (1):

10.15585/mmwr.mm6846a5

Keywords

vaccination

Heptavalent Pneumococcal Conjugate Vaccine

PMID (1):

31751323

MeSH

child

Adult

Humans

Cochlear Implants

Serogroup

Advisory Committees

clinical decision-making

long-term care

13-valent pneumococcal vaccine

23-valent pneumococcal capsular polysaccharide vaccine

Pneumococcal Infections

Updated recommendations from the ACIP regarding pneumococcal vaccination of patients > 65 years of age. James W. Mold, MD, MPH

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Two pneumococcal vaccines are currently licensed for use in adults in the United States: a 13-valent pneumococcal conjugate vaccine (PCV13 [Prevnar 13, Pfizer, Inc.]) and a 23-valent pneumococcal polysaccharide vaccine (PPSV23 [Pneumovax 23, Merck and Co., Inc.]). In 2014, the Advisory Committee on Immunization Practices (ACIP)* recommended routine use of PCV13 in series with PPSV23 for all adults aged ≥65 years based on demonstrated PCV13 safety and efficacy against PCV13-type pneumonia among adults aged ≥65 years (1). At that time, ACIP recognized that there would be a need to reevaluate this recommendation because it was anticipated that PCV13 use in children would continue to reduce disease burden among adults through reduced carriage and transmission of vaccine serotypes from vaccinated children (i.e., PCV13 indirect effects). On June 26, 2019, after having reviewed the evidence accrued during the preceding 3 years (https://www.cdc.gov/vaccines/acip/recs/grade/PCV13.html), ACIP voted to remove the recommendation for routine PCV13 use among adults aged ≥65 years and to recommend administration of PCV13 based on shared clinical decision-making for adults aged ≥65 years who do not have an immunocompromising condition,† cerebrospinal fluid (CSF) leak, or cochlear implant, and who have not previously received PCV13. ACIP recognized that some adults aged ≥65 years are potentially at increased risk for exposure to PCV13 serotypes, such as persons residing in nursing homes or other long-term care facilities and persons residing in settings with low pediatric PCV13 uptake or traveling to settings with no pediatric PCV13 program, and might attain higher than average benefit from PCV13 vaccination. When patients and vaccine providers§ engage in shared clinical decision-making for PCV13 use to determine whether PCV13 is right for a particular person, considerations might include both the person's risk for exposure to PCV13 serotypes and their risk for developing pneumococcal disease as a result of underlying medical conditions. All adults aged ≥65 years should continue to receive 1 dose of PPSV23. If the decision is made to administer PCV13, it should be given at least 1 year before PPSV23. ACIP continues to recommend PCV13 in series with PPSV23 for adults aged ≥19 years with an immunocompromising condition, CSF leak, or cochlear implant (2).

Author/s:

Matanock, A, Lee, G, Gierke, R, Kobayashi, M, Leidner, A, Pilishvili, T

Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America

John Bayhi — Fri, 01 Nov 2019 17:04:48 +0000

Date Added:

November 1, 2019

Journal/Publication:

American Journal of Respiratory and Critical Care Medicine

Publication Date:

October 1, 2019

Issue:

Volume:

200

Pages:

e45-e67

URL:

Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1164/rccm.201908-1581ST

Keywords

community-acquired pneumonia

patient management

PMID (1):

31573350

MeSH

Adult

Humans

Interdisciplinary Studies

Proton-Pump Inhibitors and Long-Term Risk of Community-Acquired Pneumonia in Older Adults

research

anti-bacterial agents

An updated guideline for management of community-acquired pneumonia. James W. Mold, MD, MPH

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Background: This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia.

Methods: A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations.

Results: The panel addressed 16 specific areas for recommendations spanning questions of diagnostic testing, determination of site of care, selection of initial empiric antibiotic therapy, and subsequent management decisions. Although some recommendations remain unchanged from the 2007 guideline, the availability of results from new therapeutic trials and epidemiological investigations led to revised recommendations for empiric treatment strategies and additional management decisions.

Conclusions: The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with community-acquired pneumonia.

Author/s:

Metlay, JP, Waterer, GW, Long, AC, Anzueto, A, Brozek, J, Crothers, K, Cooley, LA, Dean, NC, Fine, MJ, Flanders, SA, Griffin, MR, Metersky, ML, Musher, DM, Restrepo, MI, Whitney, CG

Proton‐Pump Inhibitors and Long‐Term Risk of Community‐Acquired Pneumonia in Older Adults

Tracy Ashby — Mon, 11 Mar 2019 05:00:00 +0000

Date Added:

March 11, 2019

Journal/Publication:

Journal of the American Geriatrics Society

Publisher:

American Geriatrics Society

Publication Date:

April 20, 2018

Issue:

Volume:

Pages:

1332-1338

URL:

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1111/jgs.15385

Keywords

primary care

proton pump inhibitors

PMID (1):

PMC6099478

MeSH

proton pump inhibitors

Oral Care Measures for Preventing Nursing Home-Acquired Pneumonia

primary health care

More epidemiological evidence linking PPI use to incident pneumonia in older patients. An association has also been established in patients with COPD

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Objectives

To estimate associations between long‐term use of proton pump inhibitors (PPIs) and pneumonia incidence in older adults in primary care.

Design

Longitudinal analyses of electronic medical records.

Setting

England

Participants

Individuals aged 60 and older in primary care receiving PPIs for 1 year or longer (N=75,050) and age‐ and sex‐matched controls (N=75,050).

Measurements

Net hazard ratios for pneumonia incidence in Year 2 of treatment were estimated using the prior event rate ratio (PERR), which adjusts for pneumonia incidence differences before initiation of treatment. Inverse probability weighted models adjusted for 78 demographic, disease, medication, and healthcare usage measures.

Results

During the second year after initiating treatment, PPIs were associated with greater hazard of incident pneumonia (PERR‐adjusted hazard ratio=1.82, 95% confidence interval=1.27–2.54), accounting for pretreatment pneumonia rates. Estimates were similar across age and comorbidity subgroups. Similar results were also obtained from propensity score– and inverse probability–weighted models.

Conclusion

In a large cohort of older adults in primary care, PPI prescription was associated with greater risk of pneumonia in the second year of treatment. Results were robust across alternative analysis approaches. Controversies about the validity of reported short‐term harms of PPIs should not divert attention from potential long‐term effects of PPI prescriptions on older adults.

Author/s:

Zirk-Sadowski, Jan, Masoli, Jane A., Delgada, Joao, Hamilton, Willie, Strain, W. David, Henley, William, Melzer, David, Ble, Alessandro

Oral Care Measures for Preventing Nursing Home-Acquired Pneumonia

Jeffrey Wilson — Tue, 16 Oct 2018 19:05:29 +0000

Date Added:

October 16, 2018

Journal/Publication:

Cochrane Database of Systematic Reviews

Publisher:

Cochrane Library

Publication Date:

September 27, 2018

URL:

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1002/14651858.CD012416.pub2

Keywords

PMID (1):

30264525

MeSH

Periodic professional oral care, primarily dental hygienist cleaning, probably reduces the risk of pneumonia and pneumonia-associated deaths in nursing home residents compared with usual oral care provided by nursing home staff.

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BACKGROUND:

Pneumonia occurring in residents of long-term care facilities and nursing homes can be termed 'nursing home-acquired pneumonia' (NHAP). NHAP is the leading cause of mortality among residents. NHAP may be caused by aspiration of oropharyngeal flora into the lung, and by failure of the individual's defence mechanisms to eliminate the aspirated bacteria. Oral care measures to remove or disrupt oral plaque might be effective in reducing the risk of NHAP.

OBJECTIVES:

To assess effects of oral care measures for preventing nursing home-acquired pneumonia in residents of nursing homes and other long-term care facilities.

SEARCH METHODS:

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 15 November 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 10), MEDLINE Ovid (1946 to 15 November 2017), and Embase Ovid (1980 to 15 November 2017) and Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1937 to 15 November 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. We also searched the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, and the Sciencepaper Online to 20 November 2017.

SELECTION CRITERIA:

We included randomised controlled trials (RCTs) that evaluated the effects of oral care measures (brushing, swabbing, denture cleaning mouthrinse, or combination) in residents of any age in nursing homes and other long-term care facilities.

DATA COLLECTION AND ANALYSIS:

At least two review authors independently assessed search results, extracted data, and assessed risk of bias in the included studies. We contacted study authors for additional information. We pooled data from studies with similar interventions and outcomes. We reported risk ratio (RR) for dichotomous outcomes, mean difference (MD) for continuous outcomes, and hazard ratio (HR) for time-to-event outcomes, using random-effects models.

MAIN RESULTS:

We included four RCTs (3905 participants), all of which were at high risk of bias. The studies all evaluated one comparison: professional oral care versus usual oral care. We did not pool the results from one study (N = 834 participants), which was stopped at interim analysis due to lack of a clear difference between groups.We were unable to determine whether professional oral care resulted in a lower incidence rate of NHAP compared with usual oral care over an 18-month period (hazard ratio 0.65, 95% CI 0.29 to 1.46; one study, 2513 participants analysed; low-quality evidence).We were also unable to determine whether professional oral care resulted in a lower number of first episodes of pneumonia compared with usual care over a 24-month period (RR 0.61, 95% CI 0.37 to 1.01; one study, 366 participants analysed; low-quality evidence).There was low-quality evidence from two studies that professional oral care may reduce the risk of pneumonia-associated mortality compared with usual oral care at 24-month follow-up (RR 0.41, 95% CI 0.24 to 0.72, 507 participants analysed).We were uncertain whether or not professional oral care may reduce all-cause mortality compared to usual care, when measured at 24-month follow-up (RR 0.55, 95% CI 0.27 to 1.15; one study, 141 participants analysed; very low-quality evidence).Only one study (834 participants randomised) measured adverse effects of the interventions. The study identified no serious events and 64 non-serious events, the most common of which were oral cavity disturbances (not defined) and dental staining.No studies evaluated oral care versus no oral care.

AUTHORS' CONCLUSIONS:

Although low-quality evidence suggests that professional oral care could reduce mortality due to pneumonia in nursing home residents when compared to usual care, this finding must be considered with caution. Evidence for other outcomes is inconclusive. We found no high-quality evidence to determine which oral care measures are most effective for reducing nursing home-acquired pneumonia. Further trials are needed to draw reliable conclusions.

Author/s:

Liu, Chang, Cao, Yubin, Lin, Jie, Ng, Linda, Needleman, Ian, Walsh, Tanya, Li, Chunjie

BTS Guidelines for the Management of Community Acquired Pneumonia in Adults: CURB-65

Jeffrey Wilson — Tue, 28 Aug 2018 19:22:36 +0000

Date Added:

August 28, 2018

Journal/Publication:

Thorax

Publisher:

British Thoracic Society

Publication Date:

September 24, 2009

Issue:

Pages:

iii1-iii55

URL:

BTS Guidelines for the Management of Community Acquired Pneumonia in Adults: CURB-65

Type:

Clinical Decision Aids

Format:

Article

DOI (1):

10.1136/thx.2009.121434

Keywords

decision support

CAP

PMID (1):

19783532

MeSH

https://www.ncbi.nlm.nih.gov/pubmed/19783532

Evidence-Based Clinical decision tools for deciding where to manage patients with community-acquired pneumonia. CURB-65 includes BUN; CRB-65 does not.

Free full text

The British Thoracic Society (BTS) Guidelines for the management of Community Acquired Pneumonia (CAP) in Adults was published in December 2001 and superseded Guidelines published in 1993. A web-based update of the 2001 Guidelines was published in 2004. The 2004 Guidelines assessed relevant evidence published up to August 2003.

This update represents a further assessment of published or available evidence from August 2003 to August 2008. An identical search strategy, assessment of relevance and appraisal of articles, and grading system was used.

Author/s:

British Thoracic Society Standards of Care Committee, British Thoracic Society Pneumonia Guidelines Committee

BTS Guidelines for the Management of Community Acquired Pneumonia in Adults: CRB-65

Jeffrey Wilson — Tue, 28 Aug 2018 19:19:14 +0000

Date Added:

August 28, 2018

Journal/Publication:

Thorax

Publisher:

British Thoracic Society

Publication Date:

September 24, 2009

Issue:

Pages:

iii1-iii55

URL:

Type:

Clinical Decision Aids

Format:

Article

DOI (1):

10.1136/thx.2009.121434

Keywords

decision support

CAP

PMID (1):

19783532

MeSH