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Etiologies and treatment outcomes for out-patients with community-acquired pneumonia (CAP) at Srinagarind Hospital, Khon Kaen, Thailand.
Southeast Asian J Trop Med Public Health. 2005 Sep; 36(5):1261-7.SA

Abstract

Most patients with community-acquired pneumonia are treated as out-patients with empirical therapy, since initially the etiologic agent is unknown. We prospectively assessed the etiologies and treatment outcomes of pneumonia from February 2003 to 2004 at ambulatory clinics. Forty-four patients were included with a mean age of 49.2 (SD 18.2) years. The male to female ratio was 1:1.4. The incubation period was 6.9 (SD 4.4) days. Half of the patients were healthy. Asthma and COPD were common in patients with underlying diseases. The etiologic diagnosis was determined by a sputum culture and a serology test of paired serum samples. Hemo-culture produced no growth in any patients. Atypical pathogens and H. influenzae were the most common finding, each occurring in 31.8% of the patients followed by S. pneumoniae and H. parainfluenzae (27.3% each). Twenty-two patients were infected with multiple pathogens. C. pneumoniae was the most common co-infecting pathogen. Two of 12 S. pneumoniae isolates were penicillin resistant. Nine of 14 H. influenzae isolates were cotrimoxazole resistant and 8 of 14 were not sensitive to erythromycin. For H. parainfluenzae, 11 of 12 isolates were not sensitive to erythromycin, and 7 of 12 were not sensitive to cotrimoxazole. Oral antibiotics were prescribed as out-patient treatment. Forty patients (90.9%) improved, with symptoms-score improvement averaging 6.4 days. Four patients got worse and needed a change of antibiotics, the symptoms usually worsen within 3-5 days. We conclude that, antibiotics for CAP out-patients should cover atypical pathogens, H. influenzae, S. pneumoniae and H. parainfluenzae. If the clinical symptoms do not respond after 3-5 days of out-patient treatment, resistance or an unusual organism (eg B. pseudomallei) should be considered.

Authors+Show Affiliations

Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand. wipree@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16438155

Citation

Reechaipichitkul, Wipa, et al. "Etiologies and Treatment Outcomes for Out-patients With Community-acquired Pneumonia (CAP) at Srinagarind Hospital, Khon Kaen, Thailand." The Southeast Asian Journal of Tropical Medicine and Public Health, vol. 36, no. 5, 2005, pp. 1261-7.
Reechaipichitkul W, Lulitanond V, Sawanyawisuth K, et al. Etiologies and treatment outcomes for out-patients with community-acquired pneumonia (CAP) at Srinagarind Hospital, Khon Kaen, Thailand. Southeast Asian J Trop Med Public Health. 2005;36(5):1261-7.
Reechaipichitkul, W., Lulitanond, V., Sawanyawisuth, K., Lulitanond, A., & Limpawattana, P. (2005). Etiologies and treatment outcomes for out-patients with community-acquired pneumonia (CAP) at Srinagarind Hospital, Khon Kaen, Thailand. The Southeast Asian Journal of Tropical Medicine and Public Health, 36(5), 1261-7.
Reechaipichitkul W, et al. Etiologies and Treatment Outcomes for Out-patients With Community-acquired Pneumonia (CAP) at Srinagarind Hospital, Khon Kaen, Thailand. Southeast Asian J Trop Med Public Health. 2005;36(5):1261-7. PubMed PMID: 16438155.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Etiologies and treatment outcomes for out-patients with community-acquired pneumonia (CAP) at Srinagarind Hospital, Khon Kaen, Thailand. AU - Reechaipichitkul,Wipa, AU - Lulitanond,Viraphong, AU - Sawanyawisuth,Kittisak, AU - Lulitanond,Aroonlug, AU - Limpawattana,Panita, PY - 2006/1/28/pubmed PY - 2006/4/1/medline PY - 2006/1/28/entrez SP - 1261 EP - 7 JF - The Southeast Asian journal of tropical medicine and public health JO - Southeast Asian J Trop Med Public Health VL - 36 IS - 5 N2 - Most patients with community-acquired pneumonia are treated as out-patients with empirical therapy, since initially the etiologic agent is unknown. We prospectively assessed the etiologies and treatment outcomes of pneumonia from February 2003 to 2004 at ambulatory clinics. Forty-four patients were included with a mean age of 49.2 (SD 18.2) years. The male to female ratio was 1:1.4. The incubation period was 6.9 (SD 4.4) days. Half of the patients were healthy. Asthma and COPD were common in patients with underlying diseases. The etiologic diagnosis was determined by a sputum culture and a serology test of paired serum samples. Hemo-culture produced no growth in any patients. Atypical pathogens and H. influenzae were the most common finding, each occurring in 31.8% of the patients followed by S. pneumoniae and H. parainfluenzae (27.3% each). Twenty-two patients were infected with multiple pathogens. C. pneumoniae was the most common co-infecting pathogen. Two of 12 S. pneumoniae isolates were penicillin resistant. Nine of 14 H. influenzae isolates were cotrimoxazole resistant and 8 of 14 were not sensitive to erythromycin. For H. parainfluenzae, 11 of 12 isolates were not sensitive to erythromycin, and 7 of 12 were not sensitive to cotrimoxazole. Oral antibiotics were prescribed as out-patient treatment. Forty patients (90.9%) improved, with symptoms-score improvement averaging 6.4 days. Four patients got worse and needed a change of antibiotics, the symptoms usually worsen within 3-5 days. We conclude that, antibiotics for CAP out-patients should cover atypical pathogens, H. influenzae, S. pneumoniae and H. parainfluenzae. If the clinical symptoms do not respond after 3-5 days of out-patient treatment, resistance or an unusual organism (eg B. pseudomallei) should be considered. SN - 0125-1562 UR - https://www.unboundmedicine.com/medline/citation/16438155/Etiologies_and_treatment_outcomes_for_out_patients_with_community_acquired_pneumonia__CAP__at_Srinagarind_Hospital_Khon_Kaen_Thailand_ DB - PRIME DP - Unbound Medicine ER -