Improving on Success
Recent Developments in Pnemonia Care at NYU Medical Center

Abstract

Even a common condition like pneumonia is challenging when it strikes a frail, elderly patient who has a chronic heart or lung disease. These complicated pneumonia cases are relatively uncommon at some hospitals but typical at NYU Medical Center: among 97 randomly selected pneumonia cases at NYU, only 20% of the patients had "simple" pneumonia; 80% had complicating conditions.

NYU physicians successfully treat patients with complex cases of pneumonia, but these patients may have difficulty fighting the infection and therefore require prolonged hospitalization, careful management of antibiotic therapy, and treatment of comorbidities. Drs. Joseph Lowy and Roger Wetherbee, specialists in pulmonology and infectious disease (ID), lead a taskforce that has been developing guidelines for the treatment of pneumonia. The physicians are investigating the role of sputum testing, early recognition and treatment of comorbidities, ID and pulmonary consults, and the transition from intravenous to oral antibiotic therapy.

Meeting the Challenges of Complex Cases

The treatment of pneumonia can be summarized with one word: antibiotics. But this cursory description does not do justice to the challenges involved. To administer antimicrobials (and supportive care) expertly, a physician must have a sophisticated understanding of both human physiology and microbiology, as well as up-to-date information on the strengths and weaknesses of the many drugs available.

This is especially true at NYU Medical Center, where many of the pneumonia patients are elderly, debilitated by chronic illness, or suffer concurrently from another significant ailment that makes the eradication of infection more difficult.

The physicians at NYU meet this challenge: they provide highly effective treatment for these patients, and the recovery rate is excellent. Nonetheless, Drs. Lowy and Wetherbee are dedicated to finding the optimal way to treat pneumonia. Working with other members of the Pneumonia Taskforce, as well as analysts from the Department of Clinical Evaluation, they have been conducting a series of studies to refine the existing clinical guidelines.

Investigating the Treatment of Pneumonia

• What's the best initial antibiotic?

• When should it be supplemented with or replaced by other antibiotics?

• Treat pneumonia in general or target specific organism?

• What if symptoms persist?

• What if patient has pneumonia plus heart disease?

• How does pneumonia interact with COPD (Chronic Obstructive Pulmonary Disease)?

• When is it safe to switch to oral therapy?

• When can the patient go home?

• What's next in pneumonia therapy?

Providing Answers: The Pnemonia Guidelines at NYU

• Provide suggestions on the use of chest x-rays, electrocardiograms, blood tests, and other clinical procedures.

• Recommend beginning with cefuroxime or Unasyn® in most typical cases.

• Advise that erythromycin should also be administered when "atypical" pneumonia or a Legionella infection is suspected.

• Outline criteria for making the transition from intravenous to oral antibiotics in preparation for discharge.