By Dr. W. Gifford Jones
October 22, 2000
What infection will cause the most deaths this winter? Many people will answer it's AIDS or hepatitis. But it's pneumonia. In fact, the pneumonia mortality rate is four times that of AIDS. Every year three to four million North Americans develop pneumonia. Unfortunately many die because they believe pneumonia is not a big deal.
During the winter pneumonia is seen everywhere. In the hospital emergency wad, doctors' offices and nursing homes. But most cases are acquired in the community, hence the term "Community Acquired Pneumonia (CAP)"
The person with CAP may be a busy office worker who struggle with what's often called "walking pneumonia". Or a harassed mother of toddlers. Or even a former Prime Minister. This year, Pierre Elliott Trudeau, who has always kept himself in fit physical condition, had to be admitted to hospital. His run mill flu suddenly developed into pneumonia.
Pneumonia is an infection of the lung versus infection of the airway or bronchitis. And it can vary from mild walking pneumonia to a life©threatening or fatal disease.
Community acquired pneumonia may be caused by either a virus or bacteria. The most common forms are due to streptococcus pneumoniae and hemophilus influenzae.
Pneumonia is a challenging infection for patients. Some people simply feel ill, have a cough and fever. Others complain of fatigue, chest or back pain. Still others notice a heavy feeling in the chest or difficulty breathing. And some wonder if they are sick enough to seek medical attention.
People may also be confused by the doctor's remarks. He may say, "You have pneumonia, but there's no point in giving an antibiotic because it's due to a virus infection."
Pneumonia also presents difficult challenges for the family physician. In the office it can be difficult or impossible to distinguish between bronchitis and pneumonia.
Even culture of the sputum is often unable to pinpoint the cause of pneumonia. For instance, cultures may grow several different bacteria and viruses. But the $64,00 question is which one is causing the trouble? The end result is that in half the cases the bacteria or virus cannot be identified.
This presents an obvious dilemma for the doctor. After all, before he prescribes treatment he's supposed to know what is causing the trouble. If he orders an antibiotic and pneumonia is due to a virus you may as well flush the antibiotic down the toilet. It's also possible to give an antibiotic that's ineffective against a particular strain of bacteria.
So what's the solution? Dr. Lionel Mandell is Professor of Medicine at McMaster University, in Hamilton, Ontario and a world expert on pneumonia and antibiotic resistance.
He worries that too many people with sinusitis, pharyngitis and bronchitis are being given antibiotics. And because of this frequent and questionable use, too many bacteria have become resistant to antibiotics.
Consider what's happened to penicillin in the last 55 years. Now 13 percent of community acquired pneumonia fails to respond to penicillin in North America and Europe.
The traditional way to treat pneumonia was the "stepped" approach. Doctors would initially prescribe weaker antibiotics to treat pneumonia. If the less potent antibiotic failed then they would order a stronger one. The theory being, why use an elephant gun to shoot a mouse?
The problem is that often doctors don't know whether they're shooting at a mouse or an elephant. If it's an elephant and you're using a 222 rifle it won't harm him. In fact, it allows this bacterial elephant to mutate and become even stronger.
This is what concerns Dr. Mandell who says, "The longer the bacteria are in the body the greater the risk of mutation." This is why he claims it's better to use powerful antibiotics such as Levofloxacin (Levaquin) first in a very sick patient. Then dead bacteria can't mutate.
Doctors are now using "severity of illness scores". This helps to determine what is the best antibiotic for a particular case of pneumonia. And which patients require hospital treatment.
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See your doctor if you have symptoms suggesting pneumonia. The sooner you're treated the less the risk of complications. This is particularly true if you suffer from heart, kidney or other chronic disease.
Today patients consider heart attack a major problem. But often think pneumonia is not a big deal. They can be right. But if they're wrong and pneumonia causes moderate to severe complications the risk of death can reach 25 percent.
Health costs would be reduced if all people over the age of 65 received an annual influenza vaccination. And a pneumococcal vaccination at least once in a lifetime.
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com
My book, �90 + How I Got There� can be obtained by sending $19.95 to:
Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1
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