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Adult Community-Acquired Pneumonia (ACAP) Protocol (PhilHealth 2024)

Respiratory

1. Assessment & Diagnosis

  • Clinical Signs: History of cough (24 hours to <2 weeks) PLUS abnormal vitals (RR ≥30, HR >125, or fever/hypothermia) AND abnormal chest findings (crackles, wheezing, or diminished breath sounds).
  • Imaging: Chest X-ray is required for all suspected cases. Routine CT scans are NOT recommended.
  • Risk Stratification:
  • Low Risk: Stable vitals, no altered mental state, stable/no comorbidities. Treat as outpatient.
  • Moderate/High Risk: Unstable vitals, altered mental state, decompensated comorbidities (e.g., uncontrolled diabetes, CHF, COPD), or signs of sepsis. Requires Hospital Admission.

    • 2. Management (Empiric Therapy)

  • Low Risk (Outpatient): Amoxicillin (1g TID) OR Azithromycin/Clarithromycin. If comorbidities are present: Co-amoxiclav or Cefuroxime +/- Macrolide.
  • Moderate/High Risk (Inpatient): Non-Pseudomonal Beta-lactam (e.g., Ceftriaxone, Ampicillin-Sulbactam) PLUS a Macrolide (Azithromycin/Clarithromycin).
  • MDRO Risk:
  • MRSA Risk: Add Vancomycin or Linezolid.
  • Pseudomonas Risk: Use Piperacillin-Tazobactam, Cefepime, or Ceftazidime instead of standard beta-lactam.

    • 3. Prevention

  • Vaccination: Influenza vaccination for all patients and Pneumococcal vaccination for adults ≥50 years old.
  • Lifestyle: Smoking cessation.
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    Warning Signs

    ADMISSION CRITERIA & DANGER SIGNS

  • Altered Mental State (Acute onset).
  • Hemodynamic Instability: Systolic BP <90 mmHg or severe tachycardia (>125 bpm).
  • Severe Respiratory Distress: RR ≥30 bpm or need for mechanical ventilation.
  • Decompensated Comorbidities: Uncontrolled diabetes, active malignancy, worsening CHF/COPD, or renal failure.

    • Reference

    1. Philippine Health Insurance Corporation (PhilHealth), with PSMID, PCP, and PAFP (2024). PhilHealth Circular No. 2024-0027: Quality Standards on the Diagnosis, Management, and Prevention of Adult Community-Acquired Pneumonia (ACAP).
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