111914 antibiotic use

Question 1

drugs of choice for treating MSSA infec

Answer 1

nafcillin (oxacillin)

cefazolin

Question 2

atypical pneumonia-use what antibiotics?

Answer 2

macrolides

doxycycline

Question 3

anaerobe coverage with

Answer 3

metronidazole
clindamycin
meropenem
amoxicillin-clavulante

Question 4

most common causes of community acquired pneumonia in outpatient setting

Answer 4

strep pneumo
mycoplasma pneumoniae
haemophilus influenzae

Question 5

most common causes of community acquired pneumonia in inpatient (non ICU)

Answer 5

S pneumoniae
M penumoniae
H influenzae
Legionella

Question 6

most common causes of community acquired pneumonia in inpatient (ICU)

Answer 6

usually post viral

Strep penumoniae
Staph aureus

Question 7

antibiotic choice for community acquired pneumonia in outpt

Answer 7

previously healthy-macrolide. or doxycycline.

comorbidities-pneumococcal fluoroquinolone. or beta lactam plus macrolide

Question 8

antibiotic for CAP in inpt (non ICU)

Answer 8

no PCN allergy: beta lactam plus macrolide

PCN allergy: pneumococcal fluoroquinolone

Question 9

antibiotic for CAP in inpt (ICU)

Answer 9

no PCN allergy: beta lactam plus macrolide. or pneumococcal fluoroquinolone

PCN allergy: pneumocococal fluoroquinolone plus aztreonam

Question 10

if aspiration is suspected in CAP, what should you treat with

Answer 10

add clindamycin to cover oral anaerobes if the initial regiment doesn’t cover anaerobes

Question 11

pneumococcus beta lactam to use

Answer 11

cefotaxime, ceftriaxone

Question 12

psuedomonas aeruginosa beta lactam to use

Answer 12

piperacillin/tazobactam, ceftazadime, cefepime, meropenem, imipenem

aztreonam (mono bactam)

Question 13

anti pneumococcal fluoroquinolone

Answer 13

moxifloxacin

levofloxacin

Question 14

antipseudomonal fuoroquinolones

Answer 14

ciprofloxacin

levofloxacin

Question 15

macrolides’ coverage

Answer 15

respiratory gram positive and gram negative

intracellular atypical pathogens

Question 16

fluoroquinolones’ coverage

Answer 16

pneumococcal
pseudomonal

atypical pathogens

Question 17

tetracyclines’ coverage

Answer 17

wide range of gram positive and gram negative in respiratory tract

atypical organisms

Question 18

resistant gram positive bacteria

Answer 18

vancomycin
linezolid (bone marrow suppression and neuropathy with prolonged use)
daptomycin (NOT for use in pneumonia)

Question 19

risk factors for MDROs

Answer 19

current hospitalization of more than 5 days
hospitalization in acute care hospital for more than 2 days within past 3 months

residents of a nursing home

recipients of recent IV antibiotics, chemo, or wound care

chronic dialysis recently

family member with MDROs

Question 20

pneumonia in HIV–likely it’s what organisms?

Answer 20

early: strep pneumo
late: pneumocystic jirovecii, non-tuberculous mycobacteria, histoplasma

Question 21

pneumonia in transplantation pt–likely it’s what organisms?

Answer 21

CMV
RSV
aspergillus
mucormycosis

Question 22

travel to SW US–likely what pneumonia organisms?

Answer 22

coccicoides

hantavirus

Question 23

CURB-65

Answer 23

any of the below get one point:

confusion
BUN>19 mg/dL
respiratory rate over 30
systolic BP under 90 or diastolic BP under 60
age over 65

0: low risk, consider home Rx
1: low risk, consider home Rx
2: short inpt Rx or closely observed Rx
3: severe pneumonia, admit or consider ICU
4 or 5: severe pneumonia, admit or consider ICU

Question 24

what are beta lactams used to cover for CAP?

Answer 24

typical organisms (strep pneumo, h influenzae, moraxella)

Question 25

what are the risk factors for penicillin resistant Strep pneumo?

Answer 25

``` age over 65 beta lactam therapy in past 3 months alcoholism multiple medical comobrdities (immunosuppressive illness or meds) exposure to a child in day care center ```

Question 26

for HCAP and positive risk factors for MDROs, what do you treat with?

Answer 26

broad spec antibiotic therapy anti psuedomonal beta lactam PLUS antipseudomonal fluoroquinolone OR aminoglycoside PLUS vancomycin or linezolid if MRSA suspected

Question 27

HCAP but no risk factor for MDROs, what do you treat with?

Answer 27

ceftriaxone or amp/subactam or ertapenem or fluoroquinolone