Severe Pneumonia
Also written as IV.
Chest indrawing with inability to drink is severe pneumonia (a danger sign).
What our notes say
- Chest indrawing with inability to drink is severe pneumonia (a danger sign). (Paediatrics end of 2nd semester exam (MBPE 4300): 5 October 2021, 50 MCQs)
- High-dose oral amoxicillin is effective for non-severe pneumonia. (Paediatrics end of fourth year special supplementary exam: August 2019, Paper On)
- Chest indrawing with inability to drink is severe pneumonia, which needs admission, injectable penicillin (with gentamicin) and oxygen if hypoxic. (Paediatrics main exam (MBPE 4300): 24 January 2022, Paper One, 100 MCQs, 2 short)
- This is severe pneumonia, which needs admission, benzylpenicillin with gentamicin and oxygen if hypoxic. (Paediatrics Year 6 MBChB end of semester CAT: clinical case MCQs, 29 of 30 quest)
- A is true only in the sense of a severe pneumonia, and E is also consistent with the guideline. (Paediatrics Year 6 MBChB end of semester CAT: clinical case MCQs, 29 of 30 quest)
- Severe pneumonia is reserved for danger signs such as inability to drink, convulsions, lethargy or stridor, and needs referral and injectable treatment. (Paediatrics Question Bank: 12 Clinical MCQs)
Study material on Severe Pneumonia
- Paediatrics end of 2nd semester exam (MBPE 4300): 5 October 2021, 50 MCQs
- Paediatrics end of fourth year special supplementary exam: August 2019, Paper One, 87 of 100 MCQs
- Paediatrics Year 6 MBChB end of semester CAT: clinical case MCQs, 29 of 30 questions
- End Sem Cat: Respiratory Pathology: Emphysema, ARDS, Pneumoconiosis
Practice questions on Severe Pneumonia
In a patient with severe pneumonia, a history of recent hospitalization, and risk factors for multidrug-resistant organisms like MRSA and Pseudomonas, a broad-spectrum regimen is needed. Vancomycin provides coverage for MRSA, and piperacillin-tazobactam or cefepime provides coverage for Pseudomonas.
- A) Vancomycin plus piperacillin-tazobactam
- B) Penicillin plus azithromycin
- C) Levofloxacin alone
- D) Clindamycin plus metronidazole
Answer: A. This patient has risk factors for both MRSA (recent hospitalization, nursing home) and Pseudomonas aeruginosa (severe pneumonia, likely hospital-acquired). Vancomycin is a reliable choice for MRSA coverage. Piperacillin-tazobactam is a broad-spectrum beta-lactam/beta-lactamase inhibitor combination that covers Pseudomonas and many other Gram-negative and Gram-positive bacteria. This combination provides excellent emp
A 72-year-old man is admitted to the hospital from a nursing home with severe pneumonia. He was discharged from the hospital 1 week ago after open heart surgery. The patient has no known allergies. Which of the following regimens is most appropriate for empiric coverage of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa in this patient?
- Vancomycin plus Piperacillin-tazobactam
- Ceftriaxone plus Azithromycin
- Levofloxacin monotherapy
- Linezolid plus Cefepime
Answer: A. This patient is at high risk for healthcare-associated pneumonia (HAP) with resistant pathogens. Vancomycin provides MRSA coverage, and piperacillin-tazobactam provides broad-spectrum Gram-negative coverage, including Pseudomonas. Levofloxacin alone may not adequately cover MRSA, and ceftriaxone/azithromycin is insufficient for MRSA and Pseudomonas.
A 72-year-old man is admitted to the hospital from a nursing home with severe pneumonia. He was discharged from the hospital 1 week ago after open heart surgery. The patient has no known allergies. Which of the following regimens is most appropriate for empiric coverage of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa in this patient with hospital-acquired pneumonia
- Amoxicillin-clavulanate + Doxycycline
- Ceftriaxone + Azithromycin
- Piperacillin-tazobactam + Vancomycin
- Levofloxacin monotherapy
Answer: C. This patient has risk factors for hospital-acquired pneumonia, including recent hospitalization and nursing home residence. Empiric coverage for MRSA (Vancomycin) and Pseudomonas aeruginosa (Piperacillin-tazobactam is an antipseudomonal beta-lactam) is appropriate for severe cases.
A 72-year-old post-op man needs empiric coverage for MRSA and Pseudomonas for severe pneumonia. Which regimen is best?
- Ceftriaxone and Azithromycin
- Vancomycin and Piperacillin-Tazobactam
- Ciprofloxacin alone
- Ampicillin-Sulbactam
Answer: B. Vancomycin covers MRSA; Pip-Tazo covers Pseudomonas.