Consider yourself MD MEDICINE DOCTOR and Tell me the approach to management of common respiratory system caeses

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The question is broad - covering common respiratory cases. I need to clarify scope before diving into research.

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Which respiratory cases would you like me to cover? (Select all that apply) · What level of detail do you need?

Focused on Pneumonia with detailed MD-level management. Let me search the medical library comprehensively.

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Finding Sources

Searching PubMed

"community-acquired pneumonia"[MeSH Terms] AND "management"[MeSH Terms]

Now let me read the most authoritative sections - Goldman-Cecil Medicine and Fishman's Pulmonary Diseases, plus search for HAP/VAP and severity scores:

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Finding Sources

Excellent data. Now let me read the key sections on severity scoring, empiric antibiotic therapy, and HAP:

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Now let me get the antibiotic treatment details and HAP/VAP management:

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Finding Sources

Searching Images

community acquired pneumonia chest X-ray consolidation

A multi-modal diagnostic image panel for pediatric pneumonia. (Left) An anteroposterior chest radiograph demonstrates a significant area of opacity in the right lower lobe, consistent with lung consolidation. The left lung remains relatively clear and air-filled. (Right) A corresponding transthoracic ultrasonography (TUS) of the right anterior lower lung showing a hepatized lung appearance (consolidation). The ultrasound features multiple punctate, hyperechoic (bright) spots indicated by white arrows, which represent static or dynamic air bronchograms—bubbles of air trapped within the consolidated, fluid-filled lung tissue. The clinical significance of this combination is to demonstrate the correlation between traditional radiography and point-of-care ultrasound in diagnosing community-acquired pneumonia (CAP) in children. Target educational concepts include identifying consolidation on X-ray and recognizing sonographic air bronchograms as a hallmark of pneumonia.

The composite image displays two diagnostic modalities for the chest. Image A is a frontal chest X-ray (radiography) demonstrating extensive opacification and consolidation in the left lower lung field, consistent with lobar pneumonia. The heart border is obscured, and the left costophrenic angle is obliterated. Image B is an axial computed tomography (CT) scan of the chest at the level of the heart, showing the evolution of the pathology. It reveals a large area of consolidation in the left posterior lung containing multiple low-density, hypodense regions. A white arrow points to a well-defined pulmonary abscess and surrounding cavitation within the necrotizing lung tissue. The right lung remains relatively clear on both modalities. These images illustrate the clinical progression from initial community-acquired pneumonia to necrotizing pneumonia and abscess formation, a significant complication often associated with specific bacterial pathogens or co-infections.

A posterior-anterior (PA) chest x-ray demonstrating localized pathology in the right lung. There is a notable area of increased opacity and consolidation in the right lower lobe, which partially obscures the right hemidiaphragm and suggests an infectious process such as pneumonia. In contrast, the left lung field appears relatively clear and well-aerated with normal vascular markings. The cardiac silhouette, mediastinal contours, and trachea appear within normal limits. The skeletal structures of the ribcage and clavicles are intact and clearly visible. This diagnostic image illustrates the typical radiographic presentation of community-acquired pneumonia, characterized by alveolar infiltration and consolidation in a specific anatomical lobe, used clinically to guide antibiotic treatment and monitor disease progression.

I now have comprehensive data. Let me compile the full MD-level pneumonia management guide.

🫁 Approach to Management of Pneumonia — MD Medicine Perspective

1. DEFINITION & CLASSIFICATION

Pneumonia = acute infection of the pulmonary parenchyma characterized by alveolar consolidation with inflammatory exudate.

Type	Definition
CAP (Community-Acquired)	Acquired outside hospital or within 48 hrs of admission, in a non-immunocompromised host
HAP (Hospital-Acquired)	Develops ≥48 hrs after hospital admission
VAP (Ventilator-Associated)	Develops ≥48-72 hrs after endotracheal intubation
HCAP (Healthcare-Associated)	Nursing home residents, chronic dialysis, recent IV therapy/wound care, hospitalization ≥2 days in last 90 days
Aspiration Pneumonia	Inhalation of oropharyngeal/gastric contents; typically right lower lobe or posterior upper lobes

2. CLINICAL PRESENTATION

Classic Symptoms

Fever (may be absent in elderly/immunocompromised)
Productive cough - sputum may be purulent, rusty (pneumococcal), "currant jelly" (Klebsiella)
Dyspnea, tachypnea, pleuritic chest pain
Rigors (especially pneumococcal)

Physical Examination

Sign	Finding
Inspection	Tachypnea, reduced chest expansion
Palpation	Increased tactile fremitus over consolidation
Percussion	Dullness over affected lobe
Auscultation	Bronchial breathing, crepitations, egophony, whispered pectoriloquy

3. WORKUP / INVESTIGATIONS

Minimum Required

Investigation	Purpose
Chest X-Ray PA view	Confirm diagnosis, lobar vs. interstitial pattern, complications (effusion, cavitation, abscess)
CBC with differential	Leukocytosis (bacterial), leukopenia (severe/viral)
Blood cultures × 2	Before antibiotics in ALL hospitalized patients
Sputum Gram stain + C&S	Before first antibiotic dose (≥25 WBC, <10 epithelial cells/LPF = good sample)
Serum electrolytes, BUN, creatinine	Severity scoring (CURB-65), renal dose adjustment
LFTs, ABG/SpO₂	Severity, oxygenation status

Additional Tests (Moderate-Severe / ICU)

Test	Indication
Urine Legionella antigen	All severe CAP, ICU admission, travel history
Urine pneumococcal antigen	Severe CAP, negative cultures
Respiratory viral PCR panel	Influenza, COVID-19, RSV
Procalcitonin	Guides antibiotic initiation and de-escalation
HRCT Chest	Atypical patterns, immunocompromised, non-resolving pneumonia
Bronchoscopy + BAL	Non-resolving, immunocompromised, suspected unusual pathogen
Thoracentesis	Any associated pleural effusion >1cm on lateral decubitus
MRSA nasal PCR	Risk stratification to guide vancomycin/linezolid use

4. TYPICAL CXR APPEARANCE

Lobar consolidation with air bronchograms is the hallmark of bacterial pneumonia:

Right lower lobe consolidation - typical CAP on CXR

5. SEVERITY SCORING - SITE-OF-CARE DECISION

CURB-65 Score

(1 point each - Harrison's Principles of Internal Medicine 22E)

Parameter	Threshold
C - Confusion (new onset)	Any
U - Urea (BUN)	> 7 mmol/L (>19 mg/dL)
R - Respiratory rate	≥ 30 breaths/min
B - Blood pressure	Systolic ≤90 or diastolic ≤60 mmHg
65 - Age	≥ 65 years

Management by CURB-65 score:

Score	30-day Mortality	Recommended Care
0	1.5%	Outpatient treatment
1-2	~8%	Hospitalize (may observe if only age ≥65 scores)
3-4	22%	Hospital + Consider ICU
5	~57%	ICU admission

PSI (Pneumonia Severity Index)

More accurate than CURB-65 but uses 20 variables
Class I-II (mortality <1%): outpatient
Class III (2.8%): short observation admission
Class IV-V (8-29%): hospitalize, Class V consider ICU

IDSA/ATS Criteria for Severe CAP (ICU Admission)

1 MAJOR criterion OR ≥3 MINOR criteria:

Major Criteria	Minor Criteria
Septic shock requiring vasopressors	Tachypnea ≥30/min
Respiratory failure requiring mechanical ventilation	PaO₂/FiO₂ ≤250
	Multilobar infiltrates
	Confusion/disorientation
	Uremia (BUN ≥20 mg/dL)
	Leukopenia (WBC <4000/µL)
	Thrombocytopenia (<100,000/µL)
	Hypothermia (<36°C)
	Hypotension requiring IV fluids

(Fishman's Pulmonary Diseases, Fishman et al.)

6. COMMON PATHOGENS BY PATIENT CATEGORY

(Fishman's Pulmonary Diseases and Disorders)

Patient Category	Key Pathogens
Outpatient, no comorbidities	S. pneumoniae, M. pneumoniae, C. pneumoniae, H. influenzae, respiratory viruses
Outpatient, with cardiopulmonary disease	Above + DRSP, enteric gram-negatives, anaerobes (aspiration)
Non-ICU inpatient	S. pneumoniae (incl. DRSP), H. influenzae, atypicals, enteric GNBs
Severe CAP (ICU), no Pseudomonas risk	S. pneumoniae, Legionella, H. influenzae, enteric GNBs, S. aureus, M. pneumoniae
Severe CAP with Pseudomonas risk	All above + P. aeruginosa
HAP/VAP (early, no MDR risk)	S. pneumoniae, H. influenzae, MSSA, antibiotic-sensitive GNBs
HAP/VAP (late onset / MDR risk)	All above + P. aeruginosa, MRSA, ESBL Klebsiella, Acinetobacter

Risk factors for DRSP (Drug-Resistant S. pneumoniae):

Age >65, β-lactam therapy in past 3 months, alcoholism, immunosuppression, multiple comorbidities, exposure to child in daycare

Risk factors for Pseudomonas:

Prior P. aeruginosa isolation (especially respiratory), bronchiectasis, very severe COPD, structural lung disease, broad-spectrum antibiotics, hospitalization ≥5 days

7. EMPIRIC ANTIBIOTIC THERAPY

A. Community-Acquired Pneumonia (CAP)

Outpatient - No Comorbidities (CURB-65 = 0)

Regimen	Drug
1st line	Amoxicillin 1g PO TDS × 5 days
OR Atypical coverage	Doxycycline 100mg PO BD × 5 days
Macrolide (if resistance <25%)	Azithromycin 500mg Day 1, then 250mg OD × 5 days

Outpatient - With Comorbidities (COPD, DM, renal/liver/heart disease, malignancy)

Regimen	Drug
Combination	Amoxicillin-clavulanate 875/125mg PO BD + Azithromycin 500mg OD OR
	Amoxicillin-clavulanate + Doxycycline
Monotherapy	Respiratory fluoroquinolone: Levofloxacin 750mg OD × 5d or Moxifloxacin 400mg OD × 5d

Non-ICU Inpatient (Moderate CAP - CURB-65 1-2)

Scenario	Regimen
Standard (no MDR risk)	IV Ampicillin-sulbactam 1.5-3g Q6H + Azithromycin 500mg IV OD OR Respiratory FQ (Levofloxacin 750mg IV OD)
β-lactam + Macrolide combo	Ceftriaxone 1-2g IV OD + Azithromycin 500mg IV/PO OD
Penicillin allergy	Respiratory FQ monotherapy (Levofloxacin 750mg IV OD)

Severe CAP / ICU (CURB-65 ≥3, or meets IDSA/ATS criteria)

Scenario	Regimen
No MRSA/Pseudomonas risk	Ceftriaxone 1-2g IV Q12-24H + Azithromycin 500mg IV OD OR Ceftriaxone + Levofloxacin 750mg IV OD
MRSA risk (prior isolation or nasal PCR+)	Add Vancomycin 15-20mg/kg IV Q8-12H (target AUC/MIC 400-600) OR Linezolid 600mg IV Q12H (preferred for lung penetration, exotoxin inhibition)
Pseudomonas risk	Antipseudomonal β-lactam: Piperacillin-tazobactam 4.5g IV Q6H OR Cefepime 1-2g IV Q8H OR Meropenem 1g IV Q8H + Ciprofloxacin 400mg IV Q8H (double-cover if >20% local resistance)
Legionella	Azithromycin 500mg IV OD OR Levofloxacin 750mg IV OD × 10-14 days

(Harrison's Principles 22E; Fishman's Pulmonary Diseases)

B. Hospital-Acquired Pneumonia (HAP) & VAP

(Goldman-Cecil Medicine, Table 85-10)

Group A - Early onset HAP/VAP, No MDR risk factors

Ceftriaxone 1-2g IV Q12-24H
OR Levofloxacin 750mg IV OD / Ciprofloxacin 400mg IV Q8H / Moxifloxacin 400mg IV OD
OR Ampicillin-sulbactam 1.5-3g IV Q6H
OR Ertapenem 1g IV OD

Group B - Late onset (>5 days) OR MDR risk factors

(Select 2 agents if >20% of local Pseudomonas isolates are resistant to proposed monotherapy)

Antipseudomonal cephalosporin: Ceftazidime 2g IV Q8H or Cefepime 1-2g IV Q8-12H or Ceftazidime/avibactam 2.5g IV Q8H
OR Antipseudomonal carbapenem: Meropenem 1g IV Q8H or Imipenem 500mg-1g IV Q6-8H
OR β-lactam/BLI: Piperacillin-tazobactam 4.5g IV Q6H
PLUS Vancomycin 15mg/kg IV Q12H (trough 10-15 µg/mL) OR Linezolid 600mg IV Q12H (for MRSA coverage)

8. SUPPORTIVE MANAGEMENT

Oxygenation & Respiratory Support

SpO₂ / Clinical Status	Intervention
SpO₂ <92%	Supplemental O₂ - start with nasal prongs (2-4 L/min)
Persistent hypoxemia	High-flow nasal oxygen (HFNO) 40-60 L/min, FiO₂ titrated
Moderate respiratory failure	Consider NIV (CPAP/BiPAP) - especially in immunocompromised
PaO₂/FiO₂ <200, exhaustion, altered mentation	Intubate + Mechanical ventilation

Fluid Management

IV fluids if sepsis, unable to take PO, or hemodynamic compromise
Use Sepsis-3 criteria for fluid resuscitation (30mL/kg crystalloid bolus, then reassess)
Avoid fluid overload - worsen hypoxemia

Analgesia & Antipyretics

Paracetamol 1g PO/IV Q6H for fever and pleuritic pain
NSAIDs with caution (renal impairment, elderly)

Nutrition

Early enteral nutrition (within 24-48 hrs in ICU patients)
Aspiration precautions - head of bed elevation ≥30°

DVT Prophylaxis

LMWH (Enoxaparin 40mg SC OD) for all hospitalized patients without contraindications

Adjunctive Corticosteroids

Indicated in: pneumococcal pneumonia with severe inflammation, co-existing ARDS or septic shock
Hydrocortisone 200mg/day IV (in divided doses) in septic shock not responding to fluids + vasopressors
Dexamethasone 0.15mg/kg/day × 4 days in severe pneumonia

9. ANTIBIOTIC DURATION

Setting	Duration
Outpatient CAP	5 days (if responding clinically)
Non-severe inpatient CAP	5-7 days
Severe CAP / ICU	7-10 days
Legionella	10-14 days
S. aureus (MSSA) bacteremia + pneumonia	14-28 days
MRSA pneumonia	14-21 days
HAP/VAP uncomplicated	7-8 days
HAP/VAP with P. aeruginosa or Acinetobacter	≥14 days

De-escalation principle: Narrow spectrum once culture data available; use procalcitonin kinetics (>80% fall from peak, or <0.25 ng/mL = consider stopping).

10. IV TO ORAL SWITCH (STEP-DOWN)

Switch from IV to oral antibiotics when ALL of:

Temperature <37.8°C for ≥24 hrs
Heart rate <100/min
Respiratory rate <24/min
SpO₂ >92% on room air or baseline
Able to take PO medications
Blood pressure stable

11. MONITORING RESPONSE TO TREATMENT

Timeline	Expected Response
24-48 hrs	Fever improvement, subjective improvement
48-72 hrs	Objective improvement (RR, HR, SpO₂)
3-5 days	Significant improvement; consider step-down
Day 7-10	Near resolution clinically
4-6 weeks	Radiographic resolution (may lag clinical recovery, especially in elderly)

Define treatment failure at 72 hours if: persistent fever, worsening oxygenation, new complications. Then reassess: correct diagnosis? resistant organism? non-infectious cause (PE, malignancy, drug reaction)?

12. COMPLICATIONS TO WATCH

Complication	Features	Management
Parapneumonic effusion	Dullness, reduced breath sounds	Thoracentesis if >1cm, diagnostic
Empyema	Exudate, pH <7.2, glucose <40, LDH >1000	Chest tube drainage + prolonged antibiotics
Lung abscess	Fever >2 weeks, foul sputum, CXR cavity with air-fluid level	Prolonged antibiotics (6-8 weeks), clindamycin preferred; drainage if non-responsive
ARDS	PaO₂/FiO₂ <200, bilateral infiltrates	Lung-protective ventilation (TV 6mL/kg IBW)
Septic shock	Hypotension + vasopressor requirement	Vasopressors (noradrenaline 1st line), corticosteroids, source control
Non-resolving pneumonia	No improvement at 3 months	Consider TB, malignancy, BOOP, vasculitis - bronchoscopy + biopsy

13. ASPIRATION PNEUMONIA - SPECIAL NOTE

Location: superior segment right lower lobe (supine) or posterior upper lobes
Organisms: polymicrobial - oral anaerobes (Bacteroides, Fusobacterium, Prevotella) + in hospital patients: gram-negatives, P. aeruginosa, S. aureus
Treatment: Amoxicillin-clavulanate (outpatient) or Piperacillin-tazobactam (inpatient) or Metronidazole + β-lactam for anaerobic coverage
Mortality: 15-30% for aspiration pneumonia; ~20% for lung abscess

14. PREVENTION

Strategy	Details
Pneumococcal vaccine (PCV20/PPSV23)	All adults ≥65; high-risk patients ≥19 (DM, COPD, asplenia, immunocompromised)
Influenza vaccine	Annual - all adults
COVID-19 vaccine	Updated annual boosters
Smoking cessation	Reduces risk by removing mucosal barrier damage
Oral hygiene	Reduces aspiration risk in intubated patients
HOB elevation	≥30° in ventilated patients (VAP bundle)
Hand hygiene	Core infection control

15. RECENT EVIDENCE UPDATE (2025)

A 2025 French practice guideline (SPILF/SPLF) emphasizes β-lactam monotherapy is acceptable for low-risk outpatient CAP, stepping away from mandatory dual therapy.
A 2025 meta-analysis (PMID: 40202602) on antimicrobial stewardship in hospitalized CAP confirms stewardship interventions (procalcitonin-guided therapy, shorter duration protocols) reduce antibiotic exposure without increasing mortality.
Newer agents for CAP in patients unable to use β-lactams or fluoroquinolones: lefamulin (pleuromutilin) and omadacycline (tetracycline derivative) - both with IV/PO options.

QUICK BEDSIDE PNEUMONIA MANAGEMENT FLOWCHART

Patient presents with fever + cough + dyspnea
        │
        ▼
CXR + CBC + ABG + Blood cultures + Sputum C&S
        │
        ▼
   Calculate CURB-65
        │
   ┌────┴────────────────────┐
Score 0        Score 1-2         Score ≥3 / IDSA-ATS criteria
   │               │                      │
Outpatient    Hospitalize            ICU admission
Amox 1g TDS   β-lactam +          Antipseudomonal
OR Doxy       Macrolide OR          β-lactam +
5 days        FQ 5-7 days          Macrolide/FQ
                                  ± Vancomycin/
                                    Linezolid
        │               │                      │
        └───────────────┴──────────────────────┘
                        │
              Review cultures at 48-72h
              De-escalate / narrow spectrum
                        │
              IV→PO switch when criteria met
                        │
              Discharge with follow-up CXR at 6 weeks

Sources: Harrison's Principles of Internal Medicine 22E (2025), Fishman's Pulmonary Diseases & Disorders, Goldman-Cecil Medicine (International Edition), with 2025 SPILF/SPLF Practice Guidelines and PubMed meta-analysis (PMID: 40202602).

Convert this into PPT

Reading File

Running Command

mkdir -p /tmp/workspace/pneumonia-ppt && ls /tmp/workspace/

Writing File

~/pneumonia-ppt/build_ppt.py

from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.enum.shapes import MSO_SHAPE
from io import BytesIO

# ─── Colour Palette ──────────────────────────────────────────────────────────
DARK_BLUE   = RGBColor(0x0D, 0x2C, 0x54)   # deep navy
MED_BLUE    = RGBColor(0x1A, 0x6F, 0xA8)   # mid blue
ACCENT_TEAL = RGBColor(0x00, 0xB3, 0xC6)   # teal highlight
LIGHT_BG    = RGBColor(0xF0, 0xF6, 0xFF)   # very light blue-white
WHITE       = RGBColor(0xFF, 0xFF, 0xFF)
LIGHT_GREY  = RGBColor(0xE8, 0xEE, 0xF5)
TEXT_DARK   = RGBColor(0x1A, 0x1A, 0x2E)
GREEN       = RGBColor(0x00, 0x96, 0x68)
RED         = RGBColor(0xC0, 0x39, 0x2B)
ORANGE      = RGBColor(0xE6, 0x7E, 0x22)
YELLOW_ACC  = RGBColor(0xF3, 0x9C, 0x12)

prs = Presentation()
prs.slide_width  = Inches(13.333)
prs.slide_height = Inches(7.5)

BLANK = prs.slide_layouts[6]   # blank layout


# ═══════════════════════════════════════════════════════════════════════════
# Helper Functions
# ═══════════════════════════════════════════════════════════════════════════

def add_rect(slide, x, y, w, h, fill_color, line_color=None, line_width=None):
    shp = slide.shapes.add_shape(MSO_SHAPE.RECTANGLE, Inches(x), Inches(y), Inches(w), Inches(h))
    shp.fill.solid()
    shp.fill.fore_color.rgb = fill_color
    shp.line.fill.background() if line_color is None else None
    if line_color:
        shp.line.color.rgb = line_color
        shp.line.width = Pt(line_width or 1)
    else:
        shp.line.fill.background()
    shp.shadow.inherit = False
    return shp

def add_rrect(slide, x, y, w, h, fill_color, line_color=None):
    shp = slide.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE, Inches(x), Inches(y), Inches(w), Inches(h))
    shp.fill.solid()
    shp.fill.fore_color.rgb = fill_color
    if line_color:
        shp.line.color.rgb = line_color
        shp.line.width = Pt(0.75)
    else:
        shp.line.fill.background()
    shp.shadow.inherit = False
    return shp

def add_text(slide, text, x, y, w, h, size=18, bold=False, italic=False,
             color=TEXT_DARK, align=PP_ALIGN.LEFT, valign=MSO_ANCHOR.TOP, wrap=True):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.auto_size = None
    tf.vertical_anchor = valign
    tf.margin_left  = Pt(4)
    tf.margin_right = Pt(4)
    tf.margin_top   = Pt(2)
    tf.margin_bottom= Pt(2)
    p = tf.paragraphs[0]
    p.alignment = align
    r = p.add_run()
    r.text = text
    r.font.name  = "Calibri"
    r.font.size  = Pt(size)
    r.font.bold  = bold
    r.font.italic= italic
    r.font.color.rgb = color
    return tf

def add_multiline(slide, lines, x, y, w, h, size=14, bold=False,
                  color=TEXT_DARK, align=PP_ALIGN.LEFT, line_spacing=None):
    """lines: list of (text, bold, color) tuples or plain strings"""
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left  = Pt(4)
    tf.margin_right = Pt(4)
    tf.margin_top   = Pt(2)
    tf.margin_bottom= Pt(2)
    first = True
    for item in lines:
        if isinstance(item, str):
            txt, b, c = item, bold, color
        else:
            txt, b, c = item
        if first:
            p = tf.paragraphs[0]
            first = False
        else:
            p = tf.add_paragraph()
        p.alignment = align
        if line_spacing:
            from pptx.util import Pt as _Pt
            p.line_spacing = _Pt(line_spacing)
        r = p.add_run()
        r.text = txt
        r.font.name  = "Calibri"
        r.font.size  = Pt(size)
        r.font.bold  = b
        r.font.color.rgb = c
    return tf

def slide_header(slide, title, subtitle=None):
    """Navy top bar with white title and optional subtitle."""
    add_rect(slide, 0, 0, 13.333, 1.2, DARK_BLUE)
    add_rect(slide, 0, 1.2, 13.333, 0.08, ACCENT_TEAL)
    add_text(slide, title, 0.3, 0.1, 12.5, 0.8, size=28, bold=True,
             color=WHITE, valign=MSO_ANCHOR.MIDDLE)
    if subtitle:
        add_text(slide, subtitle, 0.3, 0.85, 12.5, 0.38, size=14, italic=True,
                 color=ACCENT_TEAL, valign=MSO_ANCHOR.MIDDLE)

def slide_bg(slide):
    """Light background fill."""
    add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BG)

def section_box(slide, title, x, y, w, h, title_color=DARK_BLUE, bg=WHITE, border=MED_BLUE):
    add_rrect(slide, x, y, w, 0.42, title_color)
    add_text(slide, title, x+0.1, y+0.04, w-0.2, 0.36, size=13, bold=True,
             color=WHITE, valign=MSO_ANCHOR.MIDDLE)
    add_rrect(slide, x, y+0.4, w, h-0.4, bg, border)

def footer(slide, text="Pneumonia Management | MD Medicine Reference"):
    add_rect(slide, 0, 7.2, 13.333, 0.3, DARK_BLUE)
    add_text(slide, text, 0.3, 7.22, 12.5, 0.25, size=9, color=LIGHT_GREY,
             valign=MSO_ANCHOR.MIDDLE)


# ═══════════════════════════════════════════════════════════════════════════
# SLIDE 1 — TITLE SLIDE
# ═══════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(BLANK)
add_rect(slide, 0, 0, 13.333, 7.5, DARK_BLUE)
# decorative accent bar
add_rect(slide, 0, 3.8, 13.333, 0.12, ACCENT_TEAL)
# lung icon placeholder (text)
add_text(slide, "🫁", 5.9, 0.6, 1.5, 1.5, size=60, color=WHITE, align=PP_ALIGN.CENTER)

add_text(slide, "APPROACH TO MANAGEMENT OF", 1.5, 2.0, 10.3, 0.7,
         size=20, color=ACCENT_TEAL, align=PP_ALIGN.CENTER, bold=False)
add_text(slide, "PNEUMONIA", 1.5, 2.6, 10.3, 1.1,
         size=54, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_text(slide, "A Comprehensive MD Medicine Reference", 1.5, 3.7, 10.3, 0.55,
         size=18, italic=True, color=LIGHT_GREY, align=PP_ALIGN.CENTER)

add_rect(slide, 3.5, 4.2, 6.3, 0.06, ACCENT_TEAL)

add_multiline(slide, [
    ("Sources: Harrison's 22E  |  Fishman's Pulmonary Diseases  |  Goldman-Cecil Medicine", False, LIGHT_GREY),
    ("2025 SPILF/SPLF Practice Guidelines  |  PubMed Meta-Analysis (PMID: 40202602)", False, RGBColor(0x88,0xBB,0xDD)),
], 1.5, 4.4, 10.3, 0.9, size=12, align=PP_ALIGN.CENTER)


# ═══════════════════════════════════════════════════════════════════════════
# SLIDE 2 — CLASSIFICATION & DEFINITION
# ═══════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(BLANK)
slide_bg(slide)
slide_header(slide, "Classification of Pneumonia",
             "Acute infection of pulmonary parenchyma with alveolar consolidation")
footer(slide)

types = [
    ("CAP", "Community-Acquired", "Outside hospital or within 48h of admission\nin non-immunocompromised host", MED_BLUE),
    ("HAP", "Hospital-Acquired", "Develops ≥48 hrs after\nhospital admission", DARK_BLUE),
    ("VAP", "Ventilator-Associated", "≥48-72 hrs after\nendotracheal intubation", RGBColor(0x7D,0x3C,0x98)),
    ("HCAP", "Healthcare-Associated", "Nursing home, dialysis, recent IV therapy\nor hospitalization ≥2 days in last 90 days", ORANGE),
    ("Aspiration", "Aspiration Pneumonia", "Inhalation of oropharyngeal/gastric contents\nTypically RLL or posterior upper lobes", RED),
]

box_w = 2.3
start_x = 0.35
for i, (abbr, full, desc, col) in enumerate(types):
    bx = start_x + i * (box_w + 0.18)
    add_rrect(slide, bx, 1.45, box_w, 5.5, WHITE, col)
    # top colour band
    add_rrect(slide, bx, 1.45, box_w, 0.85, col)
    add_text(slide, abbr,  bx+0.1, 1.5,  box_w-0.2, 0.45, size=22, bold=True,
             color=WHITE, align=PP_ALIGN.CENTER, valign=MSO_ANCHOR.MIDDLE)
    add_text(slide, full, bx+0.1, 1.92, box_w-0.2, 0.32, size=11, bold=True,
             color=col, align=PP_ALIGN.CENTER)
    add_text(slide, desc, bx+0.15, 2.3, box_w-0.3, 4.4, size=12,
             color=TEXT_DARK, wrap=True)


# ═══════════════════════════════════════════════════════════════════════════
# SLIDE 3 — CLINICAL PRESENTATION
# ═══════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(BLANK)
slide_bg(slide)
slide_header(slide, "Clinical Presentation", "Symptoms, Signs & Key Physical Findings")
footer(slide)

# Symptoms column
section_box(slide, "SYMPTOMS", 0.3, 1.4, 5.8, 5.6, MED_BLUE, LIGHT_BG, MED_BLUE)
add_multiline(slide, [
    ("• Fever (may be absent in elderly/immunocompromised)", False, TEXT_DARK),
    ("", False, TEXT_DARK),
    ("• Productive cough:", False, TEXT_DARK),
    ("   - Purulent = bacterial", False, TEXT_DARK),
    ("   - Rusty = S. pneumoniae", False, TEXT_DARK),
    ("   - 'Currant jelly' = Klebsiella", False, TEXT_DARK),
    ("   - Dry/scanty = Atypicals (Mycoplasma, Chlamydia)", False, TEXT_DARK),
    ("", False, TEXT_DARK),
    ("• Dyspnea & tachypnea", False, TEXT_DARK),
    ("• Pleuritic chest pain", False, TEXT_DARK),
    ("• Rigors (especially pneumococcal)", False, TEXT_DARK),
    ("• Malaise, myalgia (atypical pneumonia)", False, TEXT_DARK),
    ("• Confusion (elderly, severe disease)", False, TEXT_DARK),
], 0.45, 1.95, 5.5, 4.9, size=13)

# Signs column
section_box(slide, "PHYSICAL EXAMINATION", 6.3, 1.4, 6.7, 5.6, DARK_BLUE, LIGHT_BG, DARK_BLUE)
exam_data = [
    ("Inspection",  "Tachypnea, reduced chest expansion"),
    ("Palpation",   "Increased tactile fremitus over consolidation"),
    ("Percussion",  "Dullness over affected lobe"),
    ("Auscultation","Bronchial breathing, crepitations,\negophony, whispered pectoriloquy"),
]
row_y = 1.95
for label, val in exam_data:
    add_rrect(slide, 6.45, row_y, 2.2, 0.55, MED_BLUE)
    add_text(slide, label, 6.5, row_y+0.05, 2.1, 0.45, size=12, bold=True, color=WHITE,
             valign=MSO_ANCHOR.MIDDLE)
    add_text(slide, val, 8.75, row_y+0.04, 4.1, 0.55, size=12, color=TEXT_DARK, wrap=True)
    row_y += 0.72


# ═══════════════════════════════════════════════════════════════════════════
# SLIDE 4 — INVESTIGATIONS
# ═══════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(BLANK)
slide_bg(slide)
slide_header(slide, "Investigations / Workup", "Minimum required + Additional for moderate-severe disease")
footer(slide)

# Left panel - Minimum
section_box(slide, "MINIMUM (ALL SUSPECTED PNEUMONIA)", 0.3, 1.4, 6.0, 5.65, GREEN, LIGHT_BG, GREEN)
inv_min = [
    ("Chest X-Ray PA", "Confirm, lobar vs. interstitial, complications"),
    ("CBC + Differential", "Leukocytosis (bacterial) or leukopenia (severe/viral)"),
    ("Blood cultures × 2", "Before antibiotics in ALL hospitalized patients"),
    ("Sputum Gram stain + C&S", "Before first dose; valid: ≥25 WBC, <10 epi cells/LPF"),
    ("Serum electrolytes/BUN/Cr", "CURB-65 scoring; renal dosing"),
    ("ABG or SpO₂", "Oxygenation status & severity"),
]
ry = 1.92
for name, desc in inv_min:
    add_rrect(slide, 0.45, ry, 2.2, 0.5, GREEN)
    add_text(slide, name, 0.5, ry+0.04, 2.1, 0.42, size=11, bold=True, color=WHITE,
             valign=MSO_ANCHOR.MIDDLE, wrap=True)
    add_text(slide, desc, 2.75, ry+0.05, 3.4, 0.44, size=11, color=TEXT_DARK, wrap=True)
    ry += 0.62

# Right panel - Additional
section_box(slide, "ADDITIONAL (MODERATE-SEVERE / ICU)", 6.5, 1.4, 6.5, 5.65, RED, LIGHT_BG, RED)
inv_adv = [
    ("Urine Legionella Ag",  "Severe CAP, ICU, travel history"),
    ("Urine Pneumococcal Ag","Severe CAP, negative cultures"),
    ("Respiratory viral PCR","Influenza, COVID-19, RSV"),
    ("Procalcitonin",        "Guide start/stop antibiotics"),
    ("HRCT Chest",           "Atypical patterns, non-resolving, immunocompromised"),
    ("Bronchoscopy + BAL",   "Non-resolving, unusual pathogen"),
    ("Thoracentesis",        "Effusion >1cm on lateral decubitus"),
    ("MRSA nasal PCR",       "Risk stratification for Vancomycin/Linezolid"),
]
ry = 1.92
for name, desc in inv_adv:
    add_rrect(slide, 6.6, ry, 2.2, 0.5, RED)
    add_text(slide, name, 6.65, ry+0.04, 2.1, 0.42, size=10, bold=True, color=WHITE,
             valign=MSO_ANCHOR.MIDDLE, wrap=True)
    add_text(slide, desc, 8.9, ry+0.05, 3.9, 0.44, size=11, color=TEXT_DARK, wrap=True)
    ry += 0.58


# ═══════════════════════════════════════════════════════════════════════════
# SLIDE 5 — SEVERITY SCORING (CURB-65 + PSI + IDSA/ATS)
# ═══════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(BLANK)
slide_bg(slide)
slide_header(slide, "Severity Scoring & Site-of-Care Decision",
             "CURB-65 | PSI | IDSA/ATS Severe CAP Criteria")
footer(slide)

# CURB-65 box
section_box(slide, "CURB-65 SCORE", 0.3, 1.4, 5.1, 5.7, MED_BLUE, LIGHT_BG, MED_BLUE)
curb = [
    ("C", "Confusion (new onset)", "1 pt"),
    ("U", "Urea (BUN) > 7 mmol/L (>19 mg/dL)", "1 pt"),
    ("R", "Respiratory rate ≥ 30/min", "1 pt"),
    ("B", "BP systolic ≤90 or diastolic ≤60 mmHg", "1 pt"),
    ("65", "Age ≥ 65 years", "1 pt"),
]
ry = 1.93
for letter, meaning, pts in curb:
    add_rrect(slide, 0.42, ry, 0.55, 0.48, DARK_BLUE)
    add_text(slide, letter, 0.43, ry+0.04, 0.52, 0.4, size=16, bold=True,
             color=ACCENT_TEAL, align=PP_ALIGN.CENTER, valign=MSO_ANCHOR.MIDDLE)
    add_text(slide, meaning, 1.02, ry+0.06, 3.6, 0.4, size=12, color=TEXT_DARK, wrap=True)
    add_text(slide, pts, 4.55, ry+0.06, 0.7, 0.4, size=12, bold=True, color=MED_BLUE,
             align=PP_ALIGN.RIGHT)
    ry += 0.56

# Score → Action table
add_text(slide, "Score → Management", 0.42, 4.78, 4.9, 0.32, size=12, bold=True, color=DARK_BLUE)
score_rows = [
    ("0",   "1.5%",   "OUTPATIENT",    GREEN),
    ("1-2", "~8%",    "HOSPITALIZE",   ORANGE),
    ("3-4", "22%",    "HOSPITAL ± ICU",RED),
    ("5",   "~57%",   "ICU",           RED),
]
headers = ["Score","Mortality","Action"]
hx = [0.42, 1.2, 2.05]
hw = [0.75, 0.82, 2.95]
ry = 5.15
# header row
for hdr, hxi, hwi in zip(headers, hx, hw):
    add_rrect(slide, hxi, ry, hwi, 0.32, DARK_BLUE)
    add_text(slide, hdr, hxi+0.04, ry+0.04, hwi-0.08, 0.24, size=11, bold=True,
             color=WHITE, align=PP_ALIGN.CENTER, valign=MSO_ANCHOR.MIDDLE)
ry += 0.32
for sc, mort, action, col in score_rows:
    vals = [sc, mort, action]
    for val, hxi, hwi in zip(vals, hx, hw):
        bg = col if val == action else LIGHT_GREY
        tc = WHITE if val == action else TEXT_DARK
        add_rrect(slide, hxi, ry, hwi, 0.3, bg, border=LIGHT_GREY)
        add_text(slide, val, hxi+0.04, ry+0.03, hwi-0.08, 0.25, size=11, bold=(val==action),
                 color=tc, align=PP_ALIGN.CENTER, valign=MSO_ANCHOR.MIDDLE)
    ry += 0.3

# IDSA/ATS severe CAP
section_box(slide, "IDSA/ATS SEVERE CAP CRITERIA (ICU ADMIT)", 5.55, 1.4, 7.5, 5.7, RED, LIGHT_BG, RED)
add_text(slide, "1 MAJOR  OR  ≥3 MINOR  criteria", 5.7, 1.92, 7.2, 0.35,
         size=13, bold=True, color=RED)

add_rrect(slide, 5.6, 2.32, 3.5, 0.32, RED)
add_text(slide, "MAJOR CRITERIA", 5.65, 2.35, 3.4, 0.26, size=12, bold=True,
         color=WHITE, valign=MSO_ANCHOR.MIDDLE)
major = [
    "Septic shock requiring vasopressors",
    "Respiratory failure requiring mechanical ventilation",
]
ry = 2.66
for m in major:
    add_text(slide, "⚠ " + m, 5.7, ry, 3.3, 0.38, size=11, color=RED, bold=True, wrap=True)
    ry += 0.4

add_rrect(slide, 9.2, 2.32, 3.7, 0.32, ORANGE)
add_text(slide, "MINOR CRITERIA", 9.25, 2.35, 3.6, 0.26, size=12, bold=True,
         color=WHITE, valign=MSO_ANCHOR.MIDDLE)
minor = [
    "Tachypnea ≥30 breaths/min",
    "PaO₂/FiO₂ ≤250",
    "Multilobar infiltrates",
    "Confusion/disorientation",
    "Uremia (BUN ≥20 mg/dL)",
    "Leukopenia (WBC <4000/µL)",
    "Thrombocytopenia (<100,000/µL)",
    "Hypothermia (<36°C)",
    "Hypotension requiring IV fluids",
]
ry = 2.66
for mn in minor:
    add_text(slide, "• " + mn, 9.25, ry, 3.55, 0.35, size=11, color=TEXT_DARK, wrap=True)
    ry += 0.36


# ═══════════════════════════════════════════════════════════════════════════
# SLIDE 6 — PATHOGENS BY CATEGORY
# ═══════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(BLANK)
slide_bg(slide)
slide_header(slide, "Common Pathogens by Patient Category",
             "Empiric antibiotic selection is guided by patient category and risk factors")
footer(slide)

pathogen_data = [
    ("Outpatient\n(No comorbidities)", 
     "S. pneumoniae, M. pneumoniae,\nC. pneumoniae, H. influenzae,\nRespiratory viruses",
     MED_BLUE),
    ("Outpatient\n(With comorbidities)",
     "Above + DRSP,\nEnteric gram-negatives,\nAnaerobes (aspiration)",
     DARK_BLUE),
    ("Non-ICU\nInpatient",
     "S. pneumoniae (incl. DRSP),\nH. influenzae, Atypicals,\nEnteric GNBs",
     RGBColor(0x7D,0x3C,0x98)),
    ("Severe CAP\n(No Pseudomonas risk)",
     "S. pneumoniae, Legionella,\nH. influenzae, GNBs,\nS. aureus, M. pneumoniae",
     RED),
    ("HAP/VAP\n(Late/MDR risk)",
     "P. aeruginosa, MRSA,\nESBL Klebsiella,\nAcinetobacter spp",
     RGBColor(0x78,0x28,0x08)),
]

bw = 2.35
sx = 0.28
for i, (cat, patho, col) in enumerate(pathogen_data):
    bx = sx + i*(bw+0.12)
    add_rrect(slide, bx, 1.42, bw, 5.55, WHITE, col)
    add_rrect(slide, bx, 1.42, bw, 0.82, col)
    add_text(slide, cat, bx+0.08, 1.48, bw-0.16, 0.7, size=13, bold=True,
             color=WHITE, align=PP_ALIGN.CENTER, valign=MSO_ANCHOR.MIDDLE, wrap=True)
    add_text(slide, patho, bx+0.1, 2.32, bw-0.2, 4.45, size=12.5,
             color=TEXT_DARK, wrap=True)

add_text(slide,
    "MDR Risk Factors: hospitalization ≥2d in past 90d | broad-spectrum ABx in past 3 months | immunosuppression | prior MRSA/Pseudomonas isolation",
    0.3, 7.05, 12.7, 0.25, size=9.5, italic=True, color=MED_BLUE)


# ═══════════════════════════════════════════════════════════════════════════
# SLIDE 7 — ANTIBIOTIC THERAPY: OUTPATIENT & NON-ICU
# ═══════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(BLANK)
slide_bg(slide)
slide_header(slide, "Empiric Antibiotic Therapy — CAP Outpatient & Non-ICU",
             "Based on IDSA/ATS Guidelines | Harrison's 22E | Fishman's Pulmonary Diseases")
footer(slide)

def abx_box(slide, title, x, y, w, h, col, items):
    add_rrect(slide, x, y, w, 0.38, col)
    add_text(slide, title, x+0.08, y+0.04, w-0.16, 0.3, size=12, bold=True,
             color=WHITE, valign=MSO_ANCHOR.MIDDLE)
    add_rrect(slide, x, y+0.36, w, h-0.36, LIGHT_BG, col)
    ry = y + 0.44
    for drug, dose, note in items:
        add_rrect(slide, x+0.08, ry, 2.8 if w>5 else 2.2, 0.32, MED_BLUE if note else col)
        add_text(slide, drug, x+0.1, ry+0.02, (2.8 if w>5 else 2.2)-0.05, 0.28, size=10.5,
                 bold=True, color=WHITE, valign=MSO_ANCHOR.MIDDLE)
        add_text(slide, dose, x+(2.95 if w>5 else 2.35), ry+0.02, w-(2.9 if w>5 else 2.3), 0.32,
                 size=10.5, color=TEXT_DARK, wrap=True)
        if note:
            ry += 0.33
            add_text(slide, "   ↳ " + note, x+0.1, ry, w-0.2, 0.25, size=9.5, italic=True,
                     color=RGBColor(0x55,0x55,0x55))
        ry += 0.38

# Outpatient - no comorbidities
abx_box(slide, "OUTPATIENT — No Comorbidities (CURB-65 = 0)", 0.3, 1.42, 6.1, 2.55, GREEN, [
    ("Amoxicillin", "1g PO TDS × 5 days", "1st line"),
    ("Doxycycline", "100mg PO BD × 5 days", "Atypical coverage"),
    ("Azithromycin", "500mg Day 1 → 250mg OD × 5 days", "If macrolide resistance <25%"),
])

# Outpatient - with comorbidities
abx_box(slide, "OUTPATIENT — With Comorbidities (COPD, DM, Heart/Renal/Liver disease)", 0.3, 3.97, 6.1, 2.9, ORANGE, [
    ("Amox-Clav + Azithromycin", "875/125mg BD + 500mg OD", "Combination regimen"),
    ("Amox-Clav + Doxycycline", "875/125mg BD + 100mg BD", "Alternative combination"),
    ("Levofloxacin", "750mg OD × 5 days", "Respiratory FQ monotherapy"),
    ("Moxifloxacin", "400mg OD × 5 days", "Alternative FQ"),
])

# Non-ICU inpatient
abx_box(slide, "NON-ICU INPATIENT (Moderate CAP — CURB-65 1-2)", 6.55, 1.42, 6.5, 2.55, MED_BLUE, [
    ("Ceftriaxone + Azithromycin", "1-2g IV OD + 500mg IV/PO OD", "Standard combination"),
    ("Amp-Sulbactam + Azithro", "1.5-3g IV Q6H + 500mg OD", "β-lactam/BLI combo"),
    ("Levofloxacin", "750mg IV/PO OD", "FQ monotherapy (if β-lactam CI)"),
])

abx_box(slide, "PENICILLIN ALLERGY (Non-ICU)", 6.55, 3.97, 6.5, 1.5, RGBColor(0x7D,0x3C,0x98), [
    ("Levofloxacin", "750mg IV/PO OD × 5-7 days", ""),
    ("Moxifloxacin", "400mg IV/PO OD × 5-7 days", ""),
])


# ═══════════════════════════════════════════════════════════════════════════
# SLIDE 8 — ANTIBIOTIC THERAPY: SEVERE CAP / ICU
# ═══════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(BLANK)
slide_bg(slide)
slide_header(slide, "Empiric Antibiotic Therapy — Severe CAP (ICU) & HAP/VAP",
             "Individualized by severity, MDR risk, MRSA/Pseudomonas status | Harrison's 22E, Goldman-Cecil")
footer(slide)

# Severe CAP left
section_box(slide, "SEVERE CAP — ICU (No MRSA/Pseudomonas risk)", 0.3, 1.42, 6.1, 2.5, RED, LIGHT_BG, RED)
add_multiline(slide, [
    ("Ceftriaxone 1-2g IV Q12-24H  +  Azithromycin 500mg IV OD", True, TEXT_DARK),
    ("       OR", False, MED_BLUE),
    ("Ceftriaxone  +  Levofloxacin 750mg IV OD", True, TEXT_DARK),
    ("       OR", False, MED_BLUE),
    ("Ampicillin-sulbactam 3g IV Q6H  +  Azithromycin", True, TEXT_DARK),
], 0.45, 1.95, 5.8, 1.75, size=12.5)

section_box(slide, "ADD FOR MRSA RISK (prior isolation or nasal PCR+)", 0.3, 4.0, 6.1, 3.2, RGBColor(0x88,0x22,0x88), LIGHT_BG, RGBColor(0x88,0x22,0x88))
add_multiline(slide, [
    ("Vancomycin 15-20 mg/kg IV Q8-12H", False, TEXT_DARK),
    ("   Target AUC/MIC 400-600  (or trough 10-15 µg/mL)", False, RGBColor(0x55,0x55,0x55)),
    ("", False, TEXT_DARK),
    ("OR  Linezolid 600mg IV Q12H  ★ PREFERRED", True, RGBColor(0x88,0x22,0x88)),
    ("   Better lung penetration + exotoxin inhibition", False, RGBColor(0x55,0x55,0x55)),
], 0.45, 4.5, 5.8, 2.5, size=12.5)

# Pseudomonas
section_box(slide, "ADD FOR PSEUDOMONAS RISK (bronchiectasis, severe COPD, structural lung disease)", 6.55, 1.42, 6.5, 3.1, ORANGE, LIGHT_BG, ORANGE)
add_multiline(slide, [
    ("Antipseudomonal β-lactam (choose 1):", True, DARK_BLUE),
    ("• Pip-Tazo 4.5g IV Q6H", False, TEXT_DARK),
    ("• Cefepime 1-2g IV Q8H", False, TEXT_DARK),
    ("• Meropenem 1g IV Q8H", False, TEXT_DARK),
    ("• Ceftazidime 2g IV Q8H", False, TEXT_DARK),
    ("", False, TEXT_DARK),
    ("PLUS (if >20% local resistance):", True, ORANGE),
    ("• Ciprofloxacin 400mg IV Q8H", False, TEXT_DARK),
    ("• OR Aminoglycoside (Amikacin/Tobramycin)", False, TEXT_DARK),
], 6.7, 1.95, 6.2, 2.45, size=12.5)

# HAP/VAP
section_box(slide, "HAP/VAP — Group A (Early onset, no MDR risk)", 6.55, 4.62, 6.5, 1.3, GREEN, LIGHT_BG, GREEN)
add_multiline(slide, [
    ("Ceftriaxone 1-2g IV Q24H  OR  Levofloxacin 750mg IV OD"),
    ("Amp-Sulbactam 1.5-3g IV Q6H  OR  Ertapenem 1g IV OD"),
], 6.7, 5.1, 6.2, 0.8, size=11.5, color=TEXT_DARK)

section_box(slide, "HAP/VAP — Group B (Late onset / MDR risk)", 6.55, 6.0, 6.5, 1.25, RED, LIGHT_BG, RED)
add_text(slide,
    "Antipseudomonal cephalosporin OR carbapenem OR Pip-Tazo  +  Vancomycin/Linezolid (MRSA)",
    6.7, 6.45, 6.2, 0.7, size=11, color=TEXT_DARK, wrap=True)


# ═══════════════════════════════════════════════════════════════════════════
# SLIDE 9 — SUPPORTIVE MANAGEMENT
# ═══════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(BLANK)
slide_bg(slide)
slide_header(slide, "Supportive Management", "Oxygenation | Fluids | Analgesia | DVT prophylaxis | Steroids")
footer(slide)

support_cols = [
    ("OXYGENATION\n& VENTILATION", MED_BLUE, [
        "SpO₂ <92%: Supplemental O₂",
        "Start: Nasal prongs 2-4 L/min",
        "Persistent: HFNO 40-60 L/min",
        "Moderate failure: NIV (CPAP/BiPAP)",
        "Severe (PaO₂/FiO₂<200, exhaustion):",
        "→ Intubate + MV",
        "  TV 6 mL/kg IBW (lung-protective)",
    ]),
    ("FLUID\nMANAGEMENT", GREEN, [
        "IV fluids if: sepsis, hemodynamic",
        "compromise, unable to take PO",
        "",
        "Sepsis 3 protocol:",
        "30mL/kg crystalloid bolus → reassess",
        "",
        "Avoid fluid overload",
        "(worsens hypoxemia)",
    ]),
    ("ANALGESIA &\nANTIPYRETICS", ORANGE, [
        "Paracetamol 1g PO/IV Q6H",
        "→ Fever + pleuritic pain",
        "",
        "NSAIDs: use with caution",
        "(renal impairment, elderly)",
        "",
        "Adequate pain control →",
        "improves respiratory effort",
    ]),
    ("DVT\nPROPHYLAXIS", RGBColor(0x7D,0x3C,0x98), [
        "LMWH (Enoxaparin 40mg SC OD)",
        "→ All hospitalized patients",
        "→ Without contraindications",
        "",
        "UFH if eGFR <30:",
        "5000U SC TDS",
    ]),
    ("ADJUNCTIVE\nSTEROIDS", RED, [
        "Indications:",
        "• Severe inflammation",
        "• Co-existing ARDS",
        "• Septic shock",
        "",
        "Hydrocortisone 200mg/d IV",
        "Dexamethasone 0.15mg/kg/d × 4d",
    ]),
]

bw = 2.32
sx = 0.28
for i, (title, col, bullets) in enumerate(support_cols):
    bx = sx + i*(bw+0.1)
    add_rrect(slide, bx, 1.42, bw, 5.68, WHITE, col)
    add_rrect(slide, bx, 1.42, bw, 0.72, col)
    add_text(slide, title, bx+0.08, 1.46, bw-0.16, 0.64, size=12.5, bold=True,
             color=WHITE, align=PP_ALIGN.CENTER, valign=MSO_ANCHOR.MIDDLE, wrap=True)
    lines = [(b, False, TEXT_DARK) if b else ("", False, TEXT_DARK) for b in bullets]
    add_multiline(slide, lines, bx+0.1, 2.2, bw-0.2, 4.7, size=11.5)


# ═══════════════════════════════════════════════════════════════════════════
# SLIDE 10 — ANTIBIOTIC DURATION & IV→PO SWITCH
# ═══════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(BLANK)
slide_bg(slide)
slide_header(slide, "Antibiotic Duration, De-escalation & IV→PO Switch",
             "Evidence-based duration | Stewardship principles")
footer(slide)

section_box(slide, "ANTIBIOTIC DURATION", 0.3, 1.42, 6.2, 5.68, MED_BLUE, LIGHT_BG, MED_BLUE)
duration_data = [
    ("Outpatient CAP", "5 days (if clinically responding)"),
    ("Non-severe inpatient CAP", "5-7 days"),
    ("Severe CAP / ICU", "7-10 days"),
    ("Legionella pneumonia", "10-14 days"),
    ("S. aureus (MSSA) + bacteremia", "14-28 days"),
    ("MRSA pneumonia", "14-21 days"),
    ("HAP/VAP (uncomplicated)", "7-8 days"),
    ("HAP/VAP with Pseudomonas/Acinetobacter", "≥14 days"),
]
ry = 1.95
for setting, dur in duration_data:
    add_rrect(slide, 0.42, ry, 3.5, 0.42, LIGHT_GREY, MED_BLUE)
    add_text(slide, setting, 0.5, ry+0.05, 3.35, 0.35, size=11.5, color=TEXT_DARK, wrap=True)
    add_rrect(slide, 3.95, ry, 2.4, 0.42, MED_BLUE)
    add_text(slide, dur, 4.0, ry+0.05, 2.3, 0.35, size=11.5, bold=True, color=WHITE,
             align=PP_ALIGN.CENTER, valign=MSO_ANCHOR.MIDDLE, wrap=True)
    ry += 0.5

add_text(slide,
    "★ De-escalation: Narrow spectrum once cultures available.\n"
    "  Procalcitonin: >80% fall from peak OR <0.25 ng/mL → consider stopping.",
    0.38, 6.45, 6.0, 0.62, size=11, italic=True, color=DARK_BLUE, wrap=True)

section_box(slide, "IV → ORAL SWITCH CRITERIA (All must be met)", 6.7, 1.42, 6.3, 5.68, GREEN, LIGHT_BG, GREEN)
switch_criteria = [
    "Temperature <37.8°C for ≥24 hours",
    "Heart rate <100/min",
    "Respiratory rate <24/min",
    "SpO₂ >92% on room air (or baseline)",
    "Able to take and absorb oral medications",
    "Haemodynamically stable (BP, HR normalized)",
    "No evidence of complications (empyema, abscess)",
]
ry = 1.95
for crit in switch_criteria:
    add_rrect(slide, 6.85, ry, 0.42, 0.38, GREEN)
    add_text(slide, "✓", 6.87, ry+0.03, 0.38, 0.3, size=14, bold=True,
             color=WHITE, align=PP_ALIGN.CENTER, valign=MSO_ANCHOR.MIDDLE)
    add_text(slide, crit, 7.35, ry+0.05, 5.5, 0.38, size=12, color=TEXT_DARK, wrap=True)
    ry += 0.52

add_text(slide,
    "Switch to oral equivalent of IV drug (same class) whenever criteria met — reduces cost, line complications, and LOS.",
    6.82, 6.45, 6.1, 0.62, size=11, italic=True, color=GREEN, wrap=True)


# ═══════════════════════════════════════════════════════════════════════════
# SLIDE 11 — MONITORING RESPONSE & COMPLICATIONS
# ═══════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(BLANK)
slide_bg(slide)
slide_header(slide, "Monitoring Response & Complications",
             "Treatment failure defined at 72 hours | Key complications to anticipate")
footer(slide)

section_box(slide, "EXPECTED TREATMENT RESPONSE", 0.3, 1.42, 5.8, 3.7, GREEN, LIGHT_BG, GREEN)
response_data = [
    ("24-48 hrs", "Fever improvement; subjective improvement"),
    ("48-72 hrs", "Objective improvement: RR, HR, SpO₂"),
    ("3-5 days", "Significant improvement; consider PO switch"),
    ("Day 7-10", "Near-complete clinical resolution"),
    ("4-6 weeks", "Radiographic resolution\n(lags clinical recovery, esp. elderly)"),
]
ry = 1.95
for time, finding in response_data:
    add_rrect(slide, 0.42, ry, 1.55, 0.52, MED_BLUE)
    add_text(slide, time, 0.45, ry+0.04, 1.48, 0.44, size=12, bold=True, color=WHITE,
             align=PP_ALIGN.CENTER, valign=MSO_ANCHOR.MIDDLE)
    add_text(slide, finding, 2.05, ry+0.06, 3.9, 0.5, size=11.5, color=TEXT_DARK, wrap=True)
    ry += 0.6

add_text(slide,
    "⚠  Treatment failure at 72h: reassess — resistant organism? Wrong diagnosis (PE, malignancy, drug reaction)? Complication?",
    0.38, 5.2, 5.65, 0.65, size=11, italic=True, color=RED, bold=True, wrap=True)

section_box(slide, "KEY COMPLICATIONS", 6.3, 1.42, 6.7, 5.68, RED, LIGHT_BG, RED)
complications = [
    ("Parapneumonic Effusion", "Dullness/reduced BS → Thoracentesis if >1cm"),
    ("Empyema", "pH <7.2, glucose <40, LDH >1000 → Chest drain + prolonged ABx"),
    ("Lung Abscess", "Fever >2wks, foul sputum, cavity on CXR → Clindamycin × 6-8wks"),
    ("ARDS", "PaO₂/FiO₂ <200, bilateral infiltrates → Lung-protective MV (6mL/kg IBW)"),
    ("Septic Shock", "Hypotension + vasopressors needed → Noradrenaline 1st line + steroids"),
    ("Non-Resolving Pneumonia", "No response at 3 months → Consider TB, malignancy, BOOP → Bronchoscopy"),
]
ry = 1.95
for comp, mgmt in complications:
    add_rrect(slide, 6.45, ry, 2.6, 0.5, RED)
    add_text(slide, comp, 6.5, ry+0.04, 2.5, 0.42, size=11, bold=True, color=WHITE,
             valign=MSO_ANCHOR.MIDDLE, wrap=True)
    add_text(slide, mgmt, 9.15, ry+0.04, 3.65, 0.5, size=11, color=TEXT_DARK, wrap=True)
    ry += 0.62


# ═══════════════════════════════════════════════════════════════════════════
# SLIDE 12 — PREVENTION
# ═══════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(BLANK)
slide_bg(slide)
slide_header(slide, "Prevention of Pneumonia",
             "Vaccinations | Infection Control | VAP Bundle | Risk Reduction")
footer(slide)

prev_items = [
    ("Pneumococcal Vaccine\nPCV20 / PPSV23", MED_BLUE,
     "All adults ≥65 years.\nHigh-risk from ≥19 yrs:\n(DM, COPD, asplenia,\nimmunocompromised)"),
    ("Influenza Vaccine", MED_BLUE,
     "Annual vaccination\nfor all adults.\nMost important in\nelderly + high-risk"),
    ("COVID-19 Vaccine", GREEN,
     "Updated annual boosters.\nReduces pneumonia\nseverity and hospitalization"),
    ("Smoking Cessation", ORANGE,
     "Removes mucosal barrier\ndamage and impaired\nmucociliary clearance.\n#1 modifiable risk"),
    ("Oral Hygiene", RED,
     "Reduces aspiration risk\nin intubated patients.\nDaily chlorhexidine mouth\ncare in ICU"),
    ("VAP Bundle (ICU)", RED,
     "HOB elevation ≥30°\nSubglottic suctioning\nDaily sedation vacation\nPVC care bundle"),
    ("Hand Hygiene", DARK_BLUE,
     "Core infection control.\n5 moments of\nhand hygiene.\nAlcohol gel at bedside"),
]

bw = 1.72
sx = 0.28
for i, (title, col, desc) in enumerate(prev_items):
    bx = sx + i*(bw+0.08)
    add_rrect(slide, bx, 1.42, bw, 5.7, WHITE, col)
    add_rrect(slide, bx, 1.42, bw, 0.7, col)
    add_text(slide, title, bx+0.06, 1.46, bw-0.12, 0.62, size=11.5, bold=True,
             color=WHITE, align=PP_ALIGN.CENTER, valign=MSO_ANCHOR.MIDDLE, wrap=True)
    add_text(slide, desc, bx+0.08, 2.18, bw-0.16, 4.75, size=11.5,
             color=TEXT_DARK, wrap=True)


# ═══════════════════════════════════════════════════════════════════════════
# SLIDE 13 — MANAGEMENT FLOWCHART
# ═══════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(BLANK)
slide_bg(slide)
slide_header(slide, "Pneumonia Management Flowchart",
             "Bedside quick reference: Diagnose → Score → Treat → Monitor → Discharge")
footer(slide)

def flow_box(slide, text, x, y, w, h, fill, text_color=WHITE, size=12):
    add_rrect(slide, x, y, w, h, fill, DARK_BLUE)
    add_text(slide, text, x+0.08, y+0.06, w-0.16, h-0.12, size=size,
             bold=True, color=text_color, align=PP_ALIGN.CENTER,
             valign=MSO_ANCHOR.MIDDLE, wrap=True)

def arrow(slide, x1, y1, x2, y2):
    from pptx.enum.shapes import MSO_CONNECTOR
    ln = slide.shapes.add_connector(MSO_CONNECTOR.STRAIGHT,
                                    Inches(x1), Inches(y1), Inches(x2), Inches(y2))
    ln.line.color.rgb = MED_BLUE
    ln.line.width = Pt(2)

# Main flow (vertical center)
flow_box(slide, "Patient: Fever + Cough + Dyspnea", 4.0, 1.42, 5.3, 0.55, DARK_BLUE, size=13)
arrow(slide, 6.65, 1.97, 6.65, 2.25)
flow_box(slide, "CXR + CBC + Blood Cultures\nSputum C&S + ABG/SpO₂", 4.0, 2.25, 5.3, 0.7, MED_BLUE, size=12)
arrow(slide, 6.65, 2.95, 6.65, 3.22)
flow_box(slide, "Calculate CURB-65", 4.75, 3.22, 3.8, 0.5, ACCENT_TEAL, TEXT_DARK, size=13)

# Three branches
arrow(slide, 4.75, 3.72, 2.5, 4.15)
arrow(slide, 6.65, 3.72, 6.65, 4.15)
arrow(slide, 8.55, 3.72, 10.8, 4.15)

flow_box(slide, "Score 0\n1.5% mortality", 1.2, 4.15, 2.6, 0.65, GREEN, size=12)
flow_box(slide, "Score 1-2\n~8% mortality", 5.35, 4.15, 2.6, 0.65, ORANGE, size=12)
flow_box(slide, "Score ≥3\n≥22% mortality", 9.5, 4.15, 2.6, 0.65, RED, size=12)

arrow(slide, 2.5, 4.8, 2.5, 5.15)
arrow(slide, 6.65, 4.8, 6.65, 5.15)
arrow(slide, 10.8, 4.8, 10.8, 5.15)

flow_box(slide, "OUTPATIENT\nAmoxicillin 1g TDS\nor Doxycycline 5d", 1.2, 5.15, 2.6, 0.8, GREEN, size=10.5)
flow_box(slide, "HOSPITALIZE\nCeftriaxone +\nAzithromycin 5-7d", 5.35, 5.15, 2.6, 0.8, ORANGE, size=10.5)
flow_box(slide, "ICU ADMISSION\nAntipseudomonal\nβ-lactam ± MRSA cover", 9.5, 5.15, 2.6, 0.8, RED, size=10.5)

# Bottom common steps
arrow(slide, 6.65, 5.95, 6.65, 6.22)
flow_box(slide, "Review cultures at 48-72h  →  De-escalate  →  IV-to-PO switch  →  Discharge + Follow-up CXR at 6 weeks",
         0.5, 6.22, 12.3, 0.55, DARK_BLUE, size=12)


# ═══════════════════════════════════════════════════════════════════════════
# SLIDE 14 — ASPIRATION PNEUMONIA
# ═══════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(BLANK)
slide_bg(slide)
slide_header(slide, "Aspiration Pneumonia — Special Considerations",
             "Polymicrobial | Location-specific | Risk factor management")
footer(slide)

section_box(slide, "PATHOPHYSIOLOGY & LOCATION", 0.3, 1.42, 6.2, 2.85, MED_BLUE, LIGHT_BG, MED_BLUE)
add_multiline(slide, [
    ("Mechanism: Inhalation of oropharyngeal or gastric contents", False, TEXT_DARK),
    ("", False, TEXT_DARK),
    ("Location (dependent on posture):", True, DARK_BLUE),
    ("• Supine: Superior segment RLL + Posterior segments upper lobes", False, TEXT_DARK),
    ("• Upright: Basal segments of RLL (gravity-dependent)", False, TEXT_DARK),
    ("• Any lobe except apices possible depending on position", False, TEXT_DARK),
], 0.45, 1.92, 5.9, 2.1, size=12.5)

section_box(slide, "ORGANISMS", 0.3, 4.37, 6.2, 2.85, DARK_BLUE, LIGHT_BG, DARK_BLUE)
add_multiline(slide, [
    ("Community (oral anaerobes):", True, DARK_BLUE),
    ("  Bacteroides, Fusobacterium, Prevotella, Microaerophilic Streptococci", False, TEXT_DARK),
    ("", False, TEXT_DARK),
    ("Hospitalized / LTC patients:", True, RED),
    ("  Gram-negatives, P. aeruginosa, S. aureus (MRSA)", False, TEXT_DARK),
], 0.45, 4.85, 5.9, 2.1, size=12.5)

section_box(slide, "TREATMENT", 6.55, 1.42, 6.5, 2.85, GREEN, LIGHT_BG, GREEN)
add_multiline(slide, [
    ("Community Aspiration (outpatient):", True, DARK_BLUE),
    ("  Amoxicillin-clavulanate 875/125mg PO BD × 7-10d", False, TEXT_DARK),
    ("", False, TEXT_DARK),
    ("Hospital/ICU Aspiration:", True, RED),
    ("  Piperacillin-tazobactam 4.5g IV Q6H", False, TEXT_DARK),
    ("  OR Meropenem 1g IV Q8H", False, TEXT_DARK),
    ("  ± Metronidazole for enhanced anaerobic coverage", False, TEXT_DARK),
], 6.7, 1.92, 6.2, 2.1, size=12.5)

section_box(slide, "COMPLICATIONS & PROGNOSIS", 6.55, 4.37, 6.5, 2.85, RED, LIGHT_BG, RED)
add_multiline(slide, [
    ("Complications:", True, DARK_BLUE),
    ("• Lung abscess (cavity + air-fluid level on CXR)", False, TEXT_DARK),
    ("  → Clindamycin 600mg IV Q8H × 6-8 weeks", False, TEXT_DARK),
    ("• Empyema → chest drain + prolonged ABx", False, TEXT_DARK),
    ("• ARDS in large-volume aspiration", False, TEXT_DARK),
    ("", False, TEXT_DARK),
    ("Mortality: 15-30%  |  Lung abscess: ~20%", True, RED),
    ("Prognosis driven by underlying predisposing condition", False, TEXT_DARK),
], 6.7, 4.85, 6.2, 2.1, size=12)


# ═══════════════════════════════════════════════════════════════════════════
# SLIDE 15 — REFERENCES & KEY TAKEAWAYS
# ═══════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(BLANK)
add_rect(slide, 0, 0, 13.333, 7.5, DARK_BLUE)
add_rect(slide, 0, 1.35, 13.333, 0.08, ACCENT_TEAL)
add_text(slide, "Key Takeaways & References", 0.4, 0.22, 12.5, 0.9,
         size=30, bold=True, color=WHITE, valign=MSO_ANCHOR.MIDDLE)
add_text(slide, "Evidence-based Pneumonia Management Summary", 0.4, 1.0, 12.5, 0.38,
         size=16, italic=True, color=ACCENT_TEAL)

takeaways = [
    ("Severity Score First", "Always calculate CURB-65 or PSI before deciding site of care"),
    ("Culture Before ABx", "Blood cultures × 2 + sputum C&S before first antibiotic dose"),
    ("Empiric Then Targeted", "Start broad empirically; de-escalate at 48-72h with culture data"),
    ("Duration Matters", "Outpatient CAP needs only 5 days if responding; avoid over-treatment"),
    ("Monitor for Failure", "Reassess at 72h; treatment failure demands diagnosis review"),
    ("MRSA PCR Guides Therapy", "Nasal MRSA PCR negative = can avoid Vancomycin in most cases"),
    ("Prevention Is Key", "PCV20 + annual flu vaccine + smoking cessation = best prophylaxis"),
]

ry = 1.58
for title, msg in takeaways:
    add_rrect(slide, 0.4, ry, 2.7, 0.46, ACCENT_TEAL)
    add_text(slide, title, 0.45, ry+0.04, 2.6, 0.38, size=12, bold=True,
             color=DARK_BLUE, valign=MSO_ANCHOR.MIDDLE)
    add_text(slide, msg, 3.2, ry+0.07, 9.7, 0.38, size=12, color=LIGHT_GREY, wrap=True)
    ry += 0.56

add_rect(slide, 0, 6.7, 13.333, 0.8, RGBColor(0x08,0x1A,0x38))
add_multiline(slide, [
    ("References: Harrison's Principles of Internal Medicine 22E (2025)  |  Fishman's Pulmonary Diseases & Disorders  |  Goldman-Cecil Medicine International Edition", False, LIGHT_GREY),
    ("2025 SPILF/SPLF Practice Guideline (doi:10.1016/j.resmer.2025.101161)  |  Antimicrobial Stewardship Meta-Analysis (PMID: 40202602, Eur J Clin Microbiol Infect Dis, 2025)", False, RGBColor(0x88,0xBB,0xDD)),
], 0.4, 6.72, 12.5, 0.66, size=9.5, align=PP_ALIGN.CENTER)


# ═══════════════════════════════════════════════════════════════════════════
# SAVE
# ═══════════════════════════════════════════════════════════════════════════
out_path = "/tmp/workspace/pneumonia-ppt/Pneumonia_Management_MD_Reference.pptx"
buf = BytesIO()
prs.save(buf)
with open(out_path, "wb") as f:
    f.write(buf.getvalue())

print(f"✅ Saved: {out_path}")
import os
print(f"   Size : {os.path.getsize(out_path):,} bytes")
print(f"   Slides: {len(prs.slides)}")

Running Command

cd /tmp/workspace/pneumonia-ppt && python build_ppt.py

Editing File

~/pneumonia-ppt/build_ppt.py

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/pneumonia-ppt/build_ppt.py'

Running Command

cd /tmp/workspace/pneumonia-ppt && python build_ppt.py

Your presentation is ready! Download it here:

Pneumonia Management MD Reference

Presentation · PPTX

The deck has 15 slides with a professional medical design (navy/teal/white theme):

Slide	Content
1	Title Slide
2	Classification (CAP / HAP / VAP / HCAP / Aspiration)
3	Clinical Presentation - Symptoms & Physical Signs
4	Investigations - Minimum Required + Additional (Moderate-Severe)
5	Severity Scoring - CURB-65 score table + IDSA/ATS ICU criteria
6	Common Pathogens by patient category
7	Empiric Antibiotic Therapy - Outpatient & Non-ICU
8	Empiric Antibiotic Therapy - Severe CAP/ICU + HAP/VAP
9	Supportive Management (O₂, fluids, analgesia, DVT prophylaxis, steroids)
10	Antibiotic Duration, De-escalation & IV→PO Switch criteria
11	Monitoring Response & Complications
12	Prevention (vaccines, VAP bundle, smoking cessation)
13	Management Flowchart (visual bedside decision tree)
14	Aspiration Pneumonia - Special considerations
15	Key Takeaways & References

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