Review of residents of an aged-care facility with CAP

Residents with community-acquired pneumonia (CAP) may improve slowly despite antibiotic therapy. However, once antibiotic therapy has started, the resident’s symptoms (eg impaired consciousness) should steadily improve. The rate of recovery is influenced by the severity of CAP and the resident’s general health and comorbidities. Appetite should improve. Cough, sputum production (if present) and chest discomfort may take several weeks to resolve and are often due to exacerbating comorbidities (eg heart failure). Residents can report fatigue for months after an episode of pneumonia. Prolonged symptoms are not an indication for extended antibiotic therapy.

If available, modify treatment based on the results of investigations, including susceptibility testing; see Directed therapy for pneumonia. If an alternative diagnosis (eg respiratory virus, heart failure, aspiration pneumonitis) is more likely based on the results of investigations or the speed of recovery, consider stopping antibiotic therapy.

If residents with CAP are not improving, reassess the diagnosis. Consider infective and noninfective diagnoses – see Approach to managing adults with CAP who are not improving. Ensure airway clearance strategies (eg chest physiotherapy) are optimised, particularly in residents with comorbid lung disease. Reassess the need for parenteral antibiotic therapy or hospital admission (see Approach to managing community-acquired pneumonia (CAP) in residents of an aged-care facility).

If CAP remains the likely diagnosis but the resident’s goals of care are not consistent with hospital admission or parenteral antibiotic therapy in the aged-care facility, use of an alternative oral antibiotic is reasonable. Residents initially treated with amoxicillin who are not improving may have CAP caused by a beta-lactamase–producing strain of Haemophilus influenzae or Moraxella catarrhalis. These pathogens are more likely in residents with comorbid lung disease. Adding clavulanate provides increased activity against these pathogens.

For residents of an aged-care facility with CAP suspected to be caused by a resistant strain of H. influenzae or M. catarrhalis (ie beta-lactamase-producing), use: