Management of Pneumonia in Outpatients

  • Richard B. Brown


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.


Obstructive Lung Disease Pneumococcal Vaccine Mycoplasma Pneumoniae Causative Pathogen Pneumococcal Pneumonia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Centers for Disease Control: Years of potential life lost by principal diagnosis, United States. Morbid Mortal Week Rep 1984; 33: 407.Google Scholar
  2. 2.
    Diehr P, Wood RW, Bushyhead J, et al: Prediction of pneumonia in outpatients with acute cough-a statistical approach. J Chron Dis 1984; 37: 215–225.PubMedCrossRefGoogle Scholar
  3. 3.
    LaForce FM: Community-acquired lower respiratory tract infections: Prevention and cost-control strategies. Am J Med 1985; 78 (suppl 6B): 52–57.PubMedCrossRefGoogle Scholar
  4. 4.
    Jacobson JT, Burke JP, Jacobson JA: Ordering patterns, collection, transport, and screening of sputum cultures in a community hospital: Evaluation of methods to improve results. Infect Control 1981; 2: 307–311.PubMedGoogle Scholar
  5. 5.
    Geckler RW, Grellion DH, McAllister CK, et al: Microscopic and bacteriologic comparison of paired sputa and transtracheal aspirates. J Clin Microbiol 1977; 6: 396–399.PubMedGoogle Scholar
  6. 6.
    Grossman M, Klein JO, McCarthy PL, et al: Concensus: Management of presumed bacterial pneumonia in ambulatory children. Pediatr Infect Dis 1984; 3: 497–500.PubMedCrossRefGoogle Scholar
  7. 7.
    Levine DP, Lerner AM: The clinical spectrum of Mycoplasma pneumoniae infections. Med Clin North Am 1978; 62: 961–978.PubMedGoogle Scholar
  8. 8.
    Jacobson JA, Jacobson JT: Pneumococcal vaccination of hospitalized patients. Clin Res 1978; 26: 397.Google Scholar
  9. 9.
    Willems JS, Sanders ER, Riddiough MA, et al: Cost-effectiveness of vaccination against pneumococcal pneumonia. N Engl J Med 1980; 303: 553–559.PubMedCrossRefGoogle Scholar
  10. 10.
    Blaser MJ, Klaus BD, Jacobson JA, et al: Comparison of cefadroxil and cephalexin in the treatment of community-acquired pneumonia. Antimicrob Agents Chemother 1984; 24: 163–167.CrossRefGoogle Scholar
  11. 11.
    Siegel D: Management of community-acquired pneumonia in outpatients. West J Med 1985; 142: 45–48.PubMedGoogle Scholar
  12. 12.
    Wald ER: Management of pneumonia in outpatients. Pediatr Infect Dis 1984; 3 (suppl): S21 - S23.CrossRefGoogle Scholar
  13. 13.
    Brown RB, Landis JN: Update on non hospital-acquired pneumonias. Prim Care 1979; 6: 463481.Google Scholar
  14. 14.
    McHenry MC: The infectious pneumonias. Hosp Pract 1980; 15: 41 /52.Google Scholar
  15. 15.
    Donowitz GR, Mandell GL: Acute pneumonia. In: Mandell GL, Douglas RG Jr, Bennett JE, eds. Principles and Practice of Infectious Disease, ed 2. New York, John Wiley & Sons, 1985: 394–407.Google Scholar
  16. 16.
    Ort S. Ryan JL, Barden G, et al: Pneumococcal pneumonia in hospitalized patients. Clinical and radiological presentations. JAMA 1983; 249: 214–218.Google Scholar
  17. 17.
    Tilghman RC, Finland M: Clinical significance of bacteremia in pneumococcic pneumonia. Arch Intern Med 1957; 59: 602–619.CrossRefGoogle Scholar
  18. 18.
    Taryle DA, Potts DE, Sahn SA: The incidence and clinical correlates of parapneumonia effusions in pneumococcal pneumonia. Chest 1978; 74: 170–173.PubMedCrossRefGoogle Scholar
  19. 19.
    Ziskind MM, Schwartz MI, George RB, et al: Incomplete consolidation in pneumococcal lobar pneumonia complicating pulmonary emphysema. Ann Intern Med 1970; 72: 835–839.PubMedCrossRefGoogle Scholar
  20. 20.
    Murray HW, Masur H, Senterfit LB, et al: The protean manifestations of Mycoplasma pneumoniae infection in adults. Am J Med 1975; 58: 229–242.PubMedCrossRefGoogle Scholar
  21. 21.
    Fine NL, Smith LR, Sheedy PF: Frequency of pleural effusions in mycoplasma and viral pneumonias. N Engl J Med 1970; 283: 790–793.PubMedCrossRefGoogle Scholar
  22. 22.
    Glassroth J, Robins AG, Snider DE: Tuberculosis in the 1980s. N Engl J Med 1980; 302: 1441 1450.Google Scholar
  23. 23.
    Centers for Disease Control: Update: Acquired immunodeficiency syndrome-United States. Morbid Mortal Week Rep 1985; 34: 245–248.Google Scholar
  24. 24.
    Walzer PD, Perl DP, Krogstad DJ, et al: Pneumocystis carinii pneumonia in the United States. Epidemiologic, diagnostic, and clinical features. Ann Intern Med 1974; 80: 83–93.PubMedCrossRefGoogle Scholar
  25. 25.
    Kovacs JA, Hiemenz JW, Macher AM, et al: Pneumocystis carinii pneumonia: A comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies. Ann Intern Med 1984; 100: 663–671.PubMedCrossRefGoogle Scholar
  26. 26.
    Bigby TD, Margolskee D, Curtis JL, et al: The usefulness of induced sputum in the diagnosis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. Am Rev Respir Dis 1986; 133: 515–518.PubMedGoogle Scholar
  27. 27.
    Jacobs MR, Path FF, Path MRC, et al: Emergence of multiply resistant pneumococci. N Engl J Med 1978; 299: 735–740.PubMedCrossRefGoogle Scholar
  28. 28.
    Roberts RB: Streptococcus pneumoniae. In: Mandell GL, Douglas RG Jr, Bennett JE, eds. Principles and Practice of Infectious Disease,ed 2. New York, John Wiley & Sons, 1985:11421152.Google Scholar
  29. 29.
    Cooksey RC, Facklam RR, Thomsberry C: Antimicrobial susceptibility patterns of Streptococcus pneumoniae. Antimicrob Agents Chemother 1978; 13: 645–648.CrossRefGoogle Scholar
  30. 30.
    O’Reilly RA, Motley CH: Racemic warfarin and trimethoprim-sulfamethoxazole interactions in humans. Ann Intern Med 1979; 91: 34–36.PubMedCrossRefGoogle Scholar
  31. 31.
    Cockerill FR III, Edson RS: Trimethoprim-sulfamethoxazole. Mayo Clin Proc 1983; 58: 147153.Google Scholar
  32. 32.
    Denny FW, Clyde WA Jr, Glezen WP: Mycoplasma pneumoniae disease: Clinical spectrum, pathophysiology, epidemiology, and control. J Infect Dis 1971; 123: 74–92.PubMedCrossRefGoogle Scholar
  33. 33.
    Doem GV, Jorgensen JH, Thomsberry C, et al: Antimicrobial resistance among clinical isolates of Haemophilus influenzae: Results of a 1986 national surveillance study. In: 27th Interscience Conference on Antimicrobial Agents and Chemotherapy,1987Google Scholar
  34. 34.
    Doern GV, Jorgensen JH, Thomsberry C, et al: Prevalence of antimicrobial resistance among clinical isolates of Haemophilus influenzae: A collaborative study. Diag Microbial Infect Dis 1986: 4: 95–107.CrossRefGoogle Scholar
  35. 35.
    Doern GV, Chapin KC: Susceptibility of Haemophilus influenzae to amoxicillin/clavulanic acid, erythromycin, cefaclor, and trimethoprim/sulfamethoxazole. Diag Microbiol Infect Dis 1986; 4: 37–41.CrossRefGoogle Scholar
  36. 36.
    Jay SJ, Johanson WG, Pierce AK: The radiographic resolution of Streptococcus pneumoniae pneumonia. N Engl J Med 1975; 293: 798–801.PubMedCrossRefGoogle Scholar
  37. 37.
    Centers for Disease Control: Recommendations for prevention and control of influenza. Ann Intern Med 1986; 105: 399–404.CrossRefGoogle Scholar
  38. 38.
    Bolan G, Broome CV, Facklam RR, et al: Pneumococcal vaccine efficacy in selected populations in the United States. Ann Intern Med 1986; 104: 1–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Simberkoff MS, Cross AP, Al-Ibrahim M, et al: Efficacy of pneumococcal vaccine in high-risk patients. N Engl J Med 1986; 315: 1318–1327.PubMedCrossRefGoogle Scholar
  40. 40.
    Forrester HL, Jahnigen DW, LaForce FM: Inefficacy of pneumococcal vaccine in a high-risk population. Am J Med 1987; 83: 425–430.PubMedCrossRefGoogle Scholar
  41. 41.
    Simberkoff MS, Cross AP, Schiffman G, et al: Further analysis of antibody responses to pneumococcal vaccine among patients enrolled in a trial of efficacy. In: 27th Interscience Conference on Antimicrobial Agents and Chemotherapy, 1987.Google Scholar

Copyright information

© Springer Science+Business Media New York 1988

Authors and Affiliations

  • Richard B. Brown

There are no affiliations available

Personalised recommendations