Recommendations from others
There are no recommendations about the use of antibiotic prophylaxis for pneumonia in either the nursing home or in the outpatient settings; however, there are clear recommendations against the overuse of antibiotics.8
The CDC Advisory Committee on Immunization Practices (ACIP) recommends:
- annual influenza vaccine for persons residing in nursing homes9
- annual influenza vaccine for health care workers in long-term care facilities9
- pneumococcal vaccine for persons residing in a nursing home (the schedule for an immunocompetent adult is a single dose, followed by a booster after age 65 if the first dose was before age 65, or after 5 years for persons <65 years with compromised immune status)10
- chemoprophylaxis for influenza outbreaks in nursing homes.11
CLINICAL COMMENTARY
Prevention is key for reducing pneumonia mortality
Jon O. Neher, MD
Valley Medical Center, Renton, Wash
Pneumonia is one of the most common causes of death for nursing home patients. While pneumonia can present with the classic fever, productive cough, and air hunger, it often presents with such nonspecific findings as altered mental status or mild tachypnea, which can significantly delay diagnosis. Additionally, many older adults poorly tolerate the metabolic demands of the disease and become critically ill very rapidly. Thus, prevention remains a key strategy for reducing mortality. Nursing home policies that facilitate vaccination and reduce disease transmission are critically important in this regard.