Clinical Practice Guidelines Management and Prevention of Adult Community Acquired Pneumonia
Community acquired pneumonia is a significant cause of morbidity and mortality among adults, still remaining as the leading cause of death from an infectious disease. Since the last publication of Philippine Clinical Practice Guidelines on the Diagnosis, Empiric Management, and Prevention of Community-acquired Pneumonia in Immunocompetent Adults in 2016, several important changes have emerged, including increasing rates of multi-drug resistant organisms (MDROs) among respiratory pathogens, the development of new antimicrobial agents meant to address these MDROs, the misuse and overuse of antimicrobial agents. It is for these reasons that an update on the management of CAP is needed.
The following are the guideline’s objectives:
- To provide an evidence–based approach to the empiric antimicrobial management and prevention of CAP in adults to help standardize care
- To update the 2016 Philippine CPG on CAP in Adults with recent and up-to-date medical evidences on new developments at the global level yet localizing it in the Philippine setting, including the increasing rates of MDROs among respiratory pathogens and the development of new antimicrobial agents meant to address these MDROs
This guideline is intended for use of medical specialists in infectious diseases, pulmonology, family medicine, as well as general practitioners, clinical practitioners, nurses and other health care providers as well as administrators, and policy makers. It can be used in the hospital and community setting—from primary to tertiary level in both private and government clinics or hospitals.
The guideline shall cover all adults, including the elderly, presenting with CAP in the outpatient and in-patient setting except:
- CAP occurring in immunocompromised patient including bone marrow, solid organ or stem cell recipient
- Patients receiving cancer chemotherapy or immune-modulators
- Long term high dose corticosteroid >30days (> or = 20mg/day prednisone or its equivalent)
- Patients with congenital and acquired immunodeficiency (including cystic fibrosis, autoimmune and HIV)
- Pneumonia in children < 18 years old
- Pulmonary tuberculosis co-infection
There are 17 priority questions identified and 30 corresponding recommendations developed by a group of experts composed of an Oversight Committee, a Guideline Writing Panel and a Technical Review Committee (Table 1). Based on the best available evidences, the quality and strength of evidence was rated using the Grading of Recommendations, Assessment, Development and evaluation (GRADE) approach. Draft recommendations were finalized after these were presented to and voted on by the members of the Consensus Panel.
Unified COVID-19 Algorithms
Last updated February 21, 2022.
The Unified COVID-19 Algorithms reflect evidence updates from the Philippine COVID-19 Living Recommendations. Version 4 is now subsumed under the Philippine COVID-19 Living Recommendations initiative in order to streamline the alignment of evidence with decision-making tools. Under this, it is funded by the Department of Health (DOH) AHEAD Program through the DOST-Philippine Council for Health Research and Development (PCHRD) and the DOH-Disease Prevention and Control Bureau (DPCB).
Version 4 is built on the grassroots effort of volunteers from different medical organizations, subject matter experts, stakeholders, as well as end-users. Facilitation was done by technical specialists from the Asia- Pacific Center for Evidence-Based Healthcare (APCEBH), Alliance for Improving Health Outcomes (AIHO), and Kalusugan ng Mag-Ina (KMI). With the Philippine context in perspective, the algorithms provide clear guidance for COVID-19 management from both the community and hospital levels. The development process was framed on evidence-based, patient-centered, and equity-driven principles.
Work on the first release of the Unified COVID-19 Algorithms started as early as March 2020 with representatives from the Philippine Society for Microbiology and Infectious Diseases (PSMID), Philippine College of Physicians (PCP), Philippine Society of General Internal Medicine (PSGIM), and the Philippine Society of Public Health Physicians (PSPHP). The Philippine College of Occupational Medicine (PCOM) and the Philippine College of Emergency Medicine (PCEM) were also among the first medical societies to join us in unifying guidance for colleagues at the frontlines. This collaboration incubated the formation of the Healthcare Professionals Alliance Against COVID-19 (HPAAC).
With continued support from PSMID, expansion was carried out by the HPAAC Steering Committee through its network of volunteers and the leadership of various medical professional societies. Major changes in the latest version include the following:
- All algorithms were streamlined for better clarity and operational feasibility, with equity lens in mind.
- The definitions of COVID-19 severities were updated based on the latest Living CPG.
- A section discussing the implications of the strength of recommendation was added.
- The duration of isolation was revised based on the latest DOH guidelines (DOH DM 2022-0013)accounting for illness severity and vaccination status.
- For severely immunocompromised patients, the need to coordinate specialist care was emphasized.
- Guidance on testing prioritization was added especially in scenarios where resources are limited (e.g., during a surge).
- Recommendations on the use of novel COVID-19 drugs in non-hospitalized settings were added.
- Recommendations on non-pharmacologic interventions for the prevention and control of COVID-19 were added.
- Personal protective equipment (PPE) levels and components were updated based on the latest Living CPG, with consideration of airborne transmission.
These algorithms are subject to change as new evidence emerges and existing guidelines are updated. Recommendations on patient care are not absolute. Final decisions remain under the discretion of the healthcare provider.
As the unified algorithms are utilized, end-users are enjoined to provide feedback as to their experience with use of the algorithms in the field through: firstname.lastname@example.org and hpaac.org.ph/contact or email@example.com.
Manual for Clinical Practice Guideline Development
You may download the PSMID Guidance on the Timing of Blood Donation among Donors Who Received COVID-19 Vaccines HERE.
PSN-PSMID-PHICS Interim Guidelines in the Prevention and Control of COVID19 Infection in Hemodialysis Facilities
Patients undergoing regular hemodialysis are considered vulnerable and thus require specific guidelines in the context of COVID-19. The goal is to minimize the risk of transmission of SARS-CoV-2 in facilities that provide routine hemodialysis services to this specific group of immunocompromised individuals. This document will guide nephrologists, physicians and other healthcare professionals practicing in hemodialysis units as they attend to patients seeking hemodialysis services in their facilities. Recommendations in this rapid guidance are based on best available evidence and will be updated as new evidence becomes available.
You may download a copy of the PSN-PSMID-PHICS Interim Guidelines in the Prevention and Control of COVID19 Infection in Hemodialysis Facilities here.
> NOTE: The COVID-19 Living Clinical Practice Guidelines contains UPDATED recommendations and evidence summaries. Click here to be redirected to the COVID LCPG.
This Interim Guidance on the Clinical Management of Adult Patients with Suspected or Confirmed COVID-19 Infection (Version 3.1) is an update of the March 31, 2020 guidelines released by the Philippine Society for Microbiology and Infectious Diseases. New evidence have been published since then necessitating this update.This document is written to guide clinicians and health care workers in their COVID-19 related management decisions. It is based on available scientific evidence that is also rapidly evolving, as more is discovered about the pathophysiology of SARS CoV-2 and the pathogenesis of the disease. As such, the recommendations in this guideline are based on limited, often low-quality evidence, and need to be carefully balanced with clinical judgment. The use of investigational drugs should be discussed with the patient or a legally authorized representative carefully outlining the potential adverse reactions and the potential clinical benefits of these investigational drugs. A signed informed consent should be obtained by the clinician.
Final PCP-PSMID-PCCP COVID-19 Guidelines 20July2020b