Working in primary care often means you'd have to deal with a lot of patients having upper and lower respiratory infections. While most of these cases are associated with common cold or flu, some of the patients may actually have community acquired, hospital or healthcare associated pneumonia, even pneumosepsis.
But before you prescribe an antibiotic, which many medical providers do when dealing with respiratory infections almost immediately (and often unnecessary), you should check the current pneumonia treatment guidelines.
For example, The American Thoracic Society (ATS) have issued joint guidelines for treatment of pneumonia together with the Infectious Disease Society of America (IDSA), which also published treatment guidelines for pediatric pneumonia separately.
Having both adult and pediatric guidelines in one spot would definitely save time for primary care providers, especially if they can carry it in their pocket all the time.
Dr Joshua Steinberg, the creator of several medical apps, including Ob Wheels app and Step-by-Step Febrile Infant app we already reviewed, put together several published guidelines, primarily the ATS and IDSA pneumonia guidelines for both adults and children, creating very useful point of care app called Pneumonia Guide.
First time you open the app, you'll see the pop up with information about the main references used. You'd also notice that the app uses the same simple layout as all other apps created by Dr Joshua Steinberg. But don't let that fool you. Below simple surface, lies an impressive content that includes not only pneumonia treatment recommendations, but also prognosis calculators and diagnostic tools, all well referenced.
On a main screen, you can choose from four different kinds of pneumonia, including three adult types (hospital acquired, health care associated and community acquired) and pediatric community acquired pneumonia. Basically, adult pneumonia has only two types, because health care associated pneumonia should be managed as either hospital acquired or community acquired pneumonia as per guidelines.The main screen also includes the currently accepted definitions for different types of pneumonia.
Tapping on any of the adult types, opens to a new screen containing several options that allow healthcare providers to quickly access the information about the treatment setting, diagnostic testing, recommended antibiotics, management and conclusion of care, which differ slightly for hospital and community acquired pneumonia.
For example, if you have a patient with hospital acquired pneumonia, you'd first get mandatory recommendations for diagnostic testing, along with additional considerations. You'd get a choice on initial antibiotics treatment, i.e. treatment with limited spectrum ABX for early onset infection, or broad spectrum for later onset infections, which also may include MDR risk.
You'd be also taken through the assessment of clinical response to antimicrobial therapy at the 48-72 hours of treatment, and to conclude the care after that. This topic basically links you to the management & conclude care topic in the Community Acquired Pneumonia section, which gives greater attention to the guidance on how to manage antibiotics and conclude the patient's care.
CAP section also allows providers to choose treatment setting, i.e. inpatient or outpatient, which also defines courses of diagnostic testing and initial antibiotic treatment.
Management and conclusion of care for CAP patients include hospital discharge criteria as well as recommendations on switching antibiotics from IV to oral if the patient's condition is improving, if they're able to take medications. It also recommends duration of antibiotic therapy for both inpatients and outpatients.
Providers will also get suggestions in case the patient's condition is not improving, i.e. considerations if the diagnosis or treatment are wrong, or if there are any complications with the initial diagnosis.
Pediatric section works in the similar fashion, allowing pediatricians to decide on to site of initial care, and offering recommendations on diagnostic testing, based on inpatient or outpatient setting, and guidance on initial antibiotic therapy, which requires the site of care is decided.
Both inpatient and outpatient empiric antibiotic therapy recommendations for children suggest medications and alternatives based upon suspected pathogen type, i.e. bacterial, viral or atypical. Pediatricians can also choose from the list of known pathogens for specific antibiotic therapy.
IDSA guidelines for children with pneumonia also address several other issues, including antibiotic management, hospital discharge criteria, what to do if children don't respond to initial therapy and how to prevent pneumonia in the future.
As you may see, the Pneumonia Guide app works well as the decision support tool (using CRB-65 severity scores) and includes a decent amount of evidence and reference.
However, Dr Joshua Steinberg stayed faithful to the initial design of all of his apps, which means we won't be knocked off our feet by some new features added, for example, a built in calculator, which would be more than helpful in decision making process.
Fortunately, we can use more than one app on our phones, which means using one of the many medical calculators available for both Android and iPhone. SteadyHealth did a review of great medical calculator app called Calculate by QxMD, which can be used as a companion to Pneumonia Guide, helping you calculate pneumonia severity index, but only if you own an iPhone, because, unfortunately, Dr Steinberg still doesn't make apps for Android devices.
The lack of built-in calculator doesn't make Pneumonia Guide bad app. On the contrary, it is amazing evidence based app to evaluate pneumonia patients at the point of care. It is well referenced throughout, containing the most current evidence based guidelines with easy to comprehend information for most medical providers.
Benefit: Healthcare providers who treat adult or pediatric pneumonia patients would need this app on their mobile devices