Pharmacotherapy/Treatment Of Pneumonia

Pneumonia is an acute respiratory tract infection that affects the lungs. The lungs get oxygen into the blood and remove carbon dioxide. This happens during breathing. When you breathe in, air travels down the back of the throat and passes through the voice box and into the windpipe (trachea). The trachea splits into two air passages (bronchial tubes). One bronchial tube leads to the left lung, the other to the right lung. You breathe 12 to 20 times per minute when you are not sick.

The lungs are made up of small sacs called alveoli. They get filled with air during the process of breathing. Pneumonia is characterized by pus and fluid filled alveoli. This prevents oxygen from getting to vital organs and makes breathing difficult.

Pneumonia is a deadly disease if not treated well. According to the world health organisation (WHO), pneumonia killed 808694 children under the age of five in 2017. That is about 15 percent of children under five. That places pneumonia as the cause of the highest number of deaths in under five children. That is bigger than malaria. It also among the cause of death in people above 65 years of age. It is most prevalent in South Asia and sub Saharan Africa. However, it is both treatable and preventable.

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Incubation period of pneumonia varies depending on the cause and the health condition of the person. It can be very fast and severe or minor without symptoms in others. Mycoplasma pneumoniae and mycobacterium tuberculosis are more contagious among the others. Infected people can transmit the infection from coughing or sneezing. However, those who begin treatment can become non contagious after like one to two days they started treatment. Contagious periods still depend on factors like type of infection. Virus pneumonia can be transmitted by persons infected up until two days after fever is clear without treatment. However, mycobacterium tuberculosis can be contagious up to two weeks or more after starting treatment.

Pneumonia symptoms
Source: Wikipedia

Cause

Pneumonia is caused by viruses, fungi, bacteria and irritants.

Fungal

Fungal pneumonia don't spread from person to person. It is not very dangerous and can be treated with antifungal agents. They may not need treatment and not common. They are gotten mostly from bird and soil contaminated with the fungi. Examples of fungal are cryptococcus species, histoplasma capsulatum fungal spores and coccidioides pneumocystis. Pneumonia caused by pneumonia jiroveci is responsible for one fourth of viral pneumonia in infants and those with HIV. Mostly common in people with weakened immune systems due to HIV and other diseases.

Symptoms

1. Feeling tired

2. Fatigue

3. Headache

4. Loss of appetite

5. Nausea and vomiting

6. Lack of energy

Bacteria

Bacteria pneumonia are common but behind viral pneumonia. They are more deadly than any other. They are highly contagious. Symptoms of bacterial pneumonia can develop gradually or suddenly. Streptococcus pneumoniae is the major cause of bacterial pneumonia. Others are mycoplasma pneumoniae, legionella pneumophila, mycoplasma pneumoniae and chlamydophila pneumoniae.

Symptoms

1. High fever (up to 39°C)

2. Tiredness (fatigue)

3. Trouble breathing: rapid breathing or shortness of breath

4. Sweating

5. Chills

6. Cough with mucus (might be greenish in color or contain a small amount of blood)

7. Chest pain and/or abdominal pain, especially with coughing or deep breathing

8. Loss of appetite

9. Confused mental state or changes in awareness (especially in older adults)

Virus

Viral pneumonia is more common than any other. However, it usually resolves without treatment within two to three weeks. viral pneumonia usually develop over a period of several days.

Viruses responsible for virus pneumonia are;

1. Haemophilus influenzae type b (Hib)

2. Respiratory syncytial virus is most common among the virus

3. Human immunodeficiency virus (HIV)

4. Rhinovirus (common cold)

5. Measles

6. Chicken pox (varicella zoster virus)

7. Adenovirus 

8. Human parainfluenza virus (HPIV)

9. Corona viruses

Early Symptoms

Early symptoms are similar to flu symptoms, which include:

1. Fever

2. Dry cough

3. Headache

4. Sore throat

5. Loss of appetite

6. Muscle pain

7. Weakness

Symptom

Additional symptoms appearing about a day later include:

1. Higher fever

2. Cough with mucus

3. Shortness of breath

Irritants

irritants like inhalation of chemicals, foods, gasses, liquids, smoking and/or dust.

General Symptoms

Watch for these ongoing symptoms that occur in pneumonia:

1. Serious congestion or chest pain.

2. Difficulty breathing.

3. A fever of 39°c or higher.

4. Coughing that produces pus.

Pneumonia In Children

The signs and symptoms of pneumonia in children vary from child to child and also depend on your child’s age, cause of the infection, and severity of their illness.

Symptoms

1. Fever, chills, general discomfort, sweating/flushed skin.

2. Cough

3. Rapid breathing (tachypnea).

4. Difficulty breathing, which can be seen as:

i. A widening of nostrils while breathing (nasal flaring)

ii. Inward movement of chest wall when a child breaths in (lower chest in-drawing). With normal breathing, chest moves outward when breathing in

iii. Wheezing

iv. Pain in chest, especially when coughing or breathing deeply

v. Bluish tint to lips or nails due to decreased oxygen level in the blood

vi. Loss of appetite

vii. Vomiting

viii. Increased tiredness (fatigue).

Babies And Toddlers Symptoms

i. Cough.

ii. Fever.

iii. Difficulty feeding.

iv. Trouble breathing. Makes a grunting sound with breathing; noisy or rattly breathing.

v. Temporarily stop breathing during sleep.

vi. Decreased amount of urine production.

vii. Pale colour

viii. Appear limp.

ix. Cry more than usual. Are restless or more fussy.

Adolescents Symptoms

i. Cough.

ii. Fever.

iii. Difficulty breathing/shortness of breath.

iv. Chest pain.

Newborns are at greater risk of pneumonia caused by bacteria present in the birth canal. In young children, viruses are the main cause of pneumonia.

Mode Of Transmission

1. Airborne

2. Blood contact like due to childbirth

Risk Factor

1. Weak immune system due to poor nutrition and age (below 2 and above 65)

2. Existing disease like HIV, asthma and measle

3. Smoking and alcohol

4. Living in crowded rooms

5. Using woods or dungs to cook leading to air pollution

6.  Neurological disorders and injuries that affect coughing

7. Hospital admitted patients

Types Of Pneumonia

Pneumonia has so many classifications. We just talk about one above which is classification based on cause. Let us see all the classification together.

1. Hospital acquired pneumonia: just as the name goes, this is Pneumonia contracted by a person admitted in the hospital. They are more dangerous because they are mostly drug resistant.

2. Ventilator associated pneumonia: this is also hospital acquired but by persons placed in ventilators.

3. Community acquired pneumonia: this is gotten outside the hospital setting.

4. Aspiration acquired Pneumonia: this is Pneumonia contracted from inhaling contaminated air from food, drinks, etc.

5. Maternal pneumonia: pneumonia that affects pregnant women. It can happen at any stage of the pregnancy but more common during the last trimester. It can lead to premature birth and low birth weight.

6. Lipoid pneumonia: is characterized by accumulation of fat within the air sac. It can be caused by aspiration of oil or associated with airway obstruction.

7. Walking pneumonia: it is a very stubborn pneumonia that occurs gradually. It also takes more time to recover. It is caused by mycoplasma pneumoniae, chlamydia pneumoniae and legionella pneumonia.

It is characterized by symptoms such as mild fever, dry cough lasting longer than a week, chills, shortness of breath, chest pain and loss of appetite.

8. Bronchopneumonia: this is pneumonia that causes inflammation of the tubes that lead from the windpipe to the lungs. The inflammation can be localised or close to the bronchi.

Stages Of Pneumonia

Lobar pneumonia: affects one or more lobes of the lungs. Lobar pneumonia is divided into four;

a. Conjugated pneumonia: it occurs within the first 24 hours after symptoms begin. Lung tissue appears heavy and congested. The air sac is filled with fluid and organisms.

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b. Red hepatization: this occurs after 2-3 days following conjugated pneumonia. the red blood cell and immune cell enter into the fluid. This makes the lung appear red and solid in appearance.

c. Grey hepatization: this occurs 2-3 days after red hepatization. The red blood cells have begun to break down but the immune cells are still intact. This forces the colour to change from red to grey.

d. Resolution: immune cells have begun to clear the infection. Productive coughs help eject remaining fluid from the lungs.

Diagnosis

1.  Chest x-ray

2. Blood culture

3. Sputum culture

4. CT scan

5. Pulse oximetry: this measures the amount of oxygen in the blood. A sensor is worn in one finger.

6. A needle can be put in between the ribs to get a fluid sample in the pleural space of the chest to check for the cause of the infection.

7. Bronchoscopy:. As a procedure a tube with a lens is inserted into the lungs to look into the airways.

8. Rapid urine tests are available to identify Streptococcus pneumoniae and Legionella pneumophila.

Complications Of Pneumonia

1. Pleural effusion

2. Lung abscess

3. Heart attack

4. Empyema

5. Sepsis

Pharmacotherapy/Treatment

Treatment plan depends on the cause of the pneumonia. Pneumonia is treated based on prevalence and resistance information. Empirical treatment of bacteria pneumonia is best treated with amoxicillin and cephalosporins like cefuroxime. Cough medication is used to suppress cough. Painkiller for the inflammatory response. Antifungal agents for fungal pneumonia.

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Critical cases that lead to shortage of oxygen in the blood can be treated with oxygen therapy.

Antiviral agents can be given for viral pneumonia. But it always resolves on its own. Antiviral agents sometimes used are deltavibir, oseltamivir and zanamivir.

Since there are many causes of pneumonia, prevention becomes a difficult task. However, there are vaccines for some types of pneumonia.

Prevnar 13 (PCV 13) is a pneumococcal conjugate vaccine used for protecting against pneumonia caused by pneumococcus bacteria. It is effective against 13 types of pneumococcal bacteria. Vaccines are suitable for children under two years old or adults above 65 year old.

Pneumovax 23 (PPSV23) is a pneumococcal polysaccharide vaccine effective against meningitis caused by pneumococcal bacteria. It is active against 23 types of pneumococcal bacteria. It is given to children and adults between 2-65 years old. Both don't prevent both from complications.

Vaccination against other types of disease can help prevent pneumonia. Flu and Hib vaccines are some examples.

They are safe but not without side effects. Vaccine is given to people with high risk. They include smokers, those who undergo bone marrow transplant, etc. There is no evidence about the safety of PCV13 or PPSV23 vaccine use in pregnancy. Women who need the vaccine should be vaccinated before a pregnancy, if possible.

Side effects of PCV13 in children include drowsiness, temporary loss of appetite, or redness, swelling, or tenderness where the shot was given. Mild fever and irritability are other common side effects. Adults receiving pneumococcal vaccines have reported pain, redness, rash, and swelling where the shot was given; also mild fever, fatigue, headache, chills, or muscle pain.

The U.S. Centers for Disease Control and Prevention (CDC) recommends two pneumococcal vaccines for all adults 65 years or older. The PCV13 and PPSV23 should not be given at the same time. When both vaccines are recommended, a dose of the PCV13 should be given first, followed by a dose of PPSV23 at another visit to a health care provider.