INTRODUCTION: This translates into about 156 million new episodes

INTRODUCTION: Pneumonia is a lung infection that is caused by fungi, virus, bacteria, or rarely by other microorganisms, other conditions such as autoimmune disease and also by certain types of drugs. It is characterized by cough, fever, chest pain and difficulty in breathing. Anyone can be affected by pneumonia, but it is most commonly present in young children and elder people. HISTORY:History of pneumonia begins with the Greek Hippocrates, dated back to fourth century B.C. A philosopher and physician “Maimonides` described pneumonia as “acute fever, sticking pain in the side, short rapid breaths, serrated pulse and cough.” Hippocrates (460 BC -370 BC) described the symptoms as: (Feigin, 2004).”Peripneumonia, and pleuritic affections, are to be thus observed: If the fever be acute, and if there be pains on either side, or in both, and if expiration be if cough be present, and the sputa expectorated be of a blood or livid color, or likewise thin, frothy, and florid, or having any other character different from the common. When pneumonia is at its height, the case is beyond remedy if he is not purged, and it is bad if he has dysponea, and urine that is thin and acrid, and if sweats come out about the neck and head, for such sweats are bad, as proceeding from the suffocation, rales, and the violence of the disease which is obtaining the upper hand.” PREVELANCE OF PNEUMONIA WORLD WIDE:According to WHO (World Health Organization) child hood pneumonia is the leading signal cause of mortality in children aged less than 5 years. The incidence in this age group is estimated to be 0.29 episode per child-year in developing and 0.05 episodes per child-year in developed countries. This translates into about 156 million new episodes each year worldwide, of which 151 million episodes are in the developing world. Most cases occur in India (43 million), China (21 million) and Pakistan (10 million), with additional high numbers in Bangladesh, Indonesia and Nigeria (6 million each). Of all community cases 13 % are severe enough to be life threatening and require hospitalization. Substantial evidence revealed that the leading risk factor contributing to pneumonia are lack of exclusive breastfeeding, undernutrition, indoor air pollution, low birth weight, crowding and lack of measles immunization. Pneumonia is responsible for about 19% of all deaths in children aged less than 5 year, of which more than 70% takes place in Sub-Saharan Africa and South-east Asia. Although based on limited available evidence recent, studies have identified Streptococcus pneumonia, Haemophilus influenza and respiratory syncytial virus as the main pathogen associated                with childhood pneumonia.PREVALENCE IN PAKISTAN: Pakistan ranks third in the list of 15 high burden countries where the estimated deaths of children by pneumonia is alarmingly high. According to the latest report, 71,000 children die of pneumonia every year in Pakistan. The report has been released by the Global Coalition against Child Pneumonia in the wake of the World Pneumonia Day 2014 which was observed on Wednesday across the world. Former Dean of Children’s Hospital Lahore Prof Tahir Masood told Dawn the major factor behind the enormous ratio of deaths among children by pneumonia was the failure of primary healthcare programmes in Pakistan and lack of commitment to fight the disease. He said the acute respiratory infection programme was launched by the World Health Organisation in Pakistan in order to prevent deaths of children under 5 by pneumonia. He said the programme was later replaced by the Integrated Management of Childhood Illness (IMCI) but after launching it as pilot project in some major cities, including Multan and Quetta, this programme also met the same fate.PATHOGENESIS:Our lungs are continuously exposed to pathogen through aspiration. Pneumonia develops after aspiration oropharyngeal secreations, inhalation of microorganisms that case pneumonia or when a bacteria from an infection in the body spreads to lungs.And if these pathogens moves to the lower respiratory tract by passing the first line of defence in the upper airways then pneumonia develops.Factor that increases the risks of pneumonia:? Advanced age.? Lung diseases.? Smoking. CAUSES OF PNEUMONIA:Pneumonia is mainly caused by bacteria and virus, but rarely by fungi in the air we breathe .our immune system prevents these germs from entering our lungs but sometime it crosses immune system and we get pneumonia. In most of the cases pneumonia is caused by streptococcus pneumonia and in children pneumonia is caused by viruses. People who are suffering from COPD and alcoholism get pneumonia by Klebsiella pneumonia and Hemophilus influenza. In children and infants, Respiratory syncytial virus (RSV) is the main cause of pneumonia.TYPES OF PNEUMONIA:We categorize pneumonia into different types:1. Community-acquired pneumonia.2. Hospital-acquired pneumonia.3. Aspiration pneumonia.4. Opportunistic pneumonia.1. COMMUNITY-ACQUIRED PNEUMONIA:Community-acquired pneumonia, or CAP, is the most common type of pneumonia, “because we can catch this pneumonia in any public place such as school, colleges or work places.60% of CAP cases are because of Streptococcus pneumonia. Community-acquired pneumonia occurs when there is:? Defect in normal host defence mechanisms.? Large infections inoculum.? Highly virulent pathogen defeats immunity2. HOSPITAL-ACQUIRERD PNEUMONIA:As the name indicates the type of pneumonia that occurs during hospital stay is known as hospital acquired pneumonia. It is severe type of pneumonia and sometimes it can be fatal. The severity is because of the organisms causing this type of pneumonia is difficult to treat because of their aggressive nature. This occurs when a person is admitted in hospital for more than 48 hours.CAUSES:Mainly by.? Staphylococcus aureas.? pseudomonas aeruginosa.3. ASPIRATION PNEUMONIA:The type of pneumonia that results from the inhalation of stomach contents ( food, saliva, liquids)  or secreations oropharynx leading to lower respiratory tract infection(Limper, AH.2011).4. OPPORTUNISTIC PNEUMONIA:Those type of patients are more susceptible to infections that involve lungs who`s having abnormal immune defence system. Mostly these infections are caused by opportunistic organism that normally does not affect individuals with normal immune system ( Mitchell, et al 2007).These organisms are called opportunistic because they take advantage of individual`s weekend immune system.CASUATIVE ORGANISMS:? cytomegalovirus? mycobacterium avium-intracellularPREVENTION OF PNEUMONIA:Germs of pneumonia are mainly transferred through coughing and sneezing so can be prevented by good hygiene habits .i.e.? pneumonia patients should use separate drinking and eating utensils.? Using tissue for coughing and sneezing.? Warm soapy water should be used for washing hands.Few types of pneumonia are cause by weak immune system so they should keep following points in mind:? Eat healthy food? Sleep well? Stay away from stress? Avoid smoking COMPLICATIONS OF PNEUMONIA:? Pleural suffusion? Bacteria in bloodstream? Respiratory failure? Lung abscesses.GUIDELINES FOR MANAGEMENT OF PNEUMONIA IN CHILDREN:First of all amoxicillin should be used as first line therapy in less severe pneumonia for infants and children younger than five years and who are previously immunized. Macrolide should be prescribed to outpatients who are more than 5 years and adults.Ampicillin or penicillin G should be prescribed to infants and school-aged children who are fully immunized and are hospitalized and their local epidemiologic data shows substantial high-level of penicillin resistance.Infants and children who are not fully immunized should be prescribed third generation parenteral cephalosporin’s (ceftriaxone and cefotaxime) (Dean, et al 2006). AIMS AND OBJECTIVES:? To observe drug-drug interactions, drug-food interactions, drug- disease interaction, irrational use of drugs, pharmacoeconomics, adverse drugs reactions, complaints of patient about current therapy and poly pharmacy.? To know about the most common drugs indicated for the treatment of pneumonia.? To educate the patient on the potential ADRS of the drugs to enhance the patient adherence to his therapy. 


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