Management of Pneumonia in Outpatients
Pneumonia constitutes one of the most frequent and perplexing infections facing the primary care physician. In pediatric practice, this disease constitutes 13% of infections demonstrated during the first 2 years of life. Under the best of circumstances the diagnosis may be easily made, although the exact etiology may be difficult to prove. However, in patients with underlying cardiopulmonary disease and those at the extremes of age, the diagnosis may prove to be more difficult. Unlike both acute bronchitis and some cases of exacerbations of chronic bronchitis, which often are self-limited diseases, pneumonia is associated with significant morbidity and mortality.1 Thus, the physician must be comfortable with the likely etiologies and therapeutic strategies to be utilized. Etiologic diagnosis usually rests on demonstrating the causative pathogen in respiratory secretions, blood, or pleural fluid. This process is complicated by the potential for contamination of expectorated sputum by organisms colonizing the upper respiratory tract and the fact that the majority of patients may be unable to provide a satisfactory expectorated specimen devoid of upper respiratory contaminants. Thus, many patients will have to be treated empirically based on information provided from history and physical examination.
KeywordsObstructive Lung Disease Pneumococcal Vaccine Mycoplasma Pneumoniae Causative Pathogen Pneumococcal Pneumonia
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