Information on popular complementary and alternative medical topics

Most patients with community-acquired pneumonia should begin to show clinical response within 3 days. If the patient is improving clinically (with improvement of the fever curve, decreased dyspnea, and decreasing white blood cell count), a switch to oral therapy should be attempted only if the patient is able to tolerate oral medications. Certain nodical conditions are associated with delayed response, including immunosuppression, alcoholism, age greater than 65 years, and multiple Medical conditions. Multilobar pneumonia and bacteremia are also associated with delayed resolution. If a patient fails to improve after several days or deteriorates clinically, this may be due to inadequate initial therapy, unusual pathogens not covered by usual empiric therapy, a complication of pneumonia, or an incorrect initial diagnosis. The initial diagnosis should be questioned, with repeat history focusing on any possible exposures (primarily HIV risk factors, pets, and recent travel) that may suggest unusual pathogens such as Pneumocystis carinii, fungal pneumonia, or psittacosis. Careful repeat physical examination may suggest complications of pneumonia, including empyema, meningitis, septic arthritis, and endocarditis.Conditions other than pneumonia could account for the clinical presentation. Pulmonary embolism, malignancy, congestive heart failure, hypersensitivity pneumonitis, vasculitis, and sarcoidosis can all mimic pneumonia and should be considered. Bronchoscopy may be considered in patients who failed to improve on initial empiric antibiotics for community-acquired pneumonia. Current evidence suggests that the yield of bronchoscopy is low, except in nonsmoking patients with multilobar disease.*44/348/5*

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Whereas the overwhelming majority of childhood colds cure them’ selves without complications, there are times when the infection leads to something more serious. The medical magazine Contemporary Pediatrics has issued the recommendations that follow.
Call the child’s physician immediately—at any time of the day or night—for any of the following:
A fever in a child of over 104 ° F.
A fever in an infant under 2 months of age of over 100.4°F.
The child is having great difficulty breathing even after you have cleared the nose of mucus.
The child is so irritable that he or she cannot be comforted.
The child is very lethargic and can’t be awakened.
Call the child’s physician during office hours if any of the following problems arise:
An earache or bad headache.
Yellow discharge or pus from the eyes.
A fever lasting more than 4 days.
Raw, possibly infected skin under the nostrils.
Noticeable wheezing or a change in the child’s normal breathing pattern.
*34\296\2*

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