31 Respiratory antibiotics and use thereof

Question 0

Adverse drug effects

Answer 0

Cephalosporins- AMS

Floroquinolones- hypoglycemia and tendonitis

Question 1

MSSA

Answer 1

Cefazolin(gram+ and -), oxacillin(gram + only), nafcillin

Question 2

CAP treatment in previously health individual

Answer 2

Macrolide (Azithromycin)

or

Doxycycline

Question 3

Atypical pneumonia Tx

Answer 3

• Legionella, Mycoplasma, chlamydia
• Macrolide - Azithro, Erythro, Clarithro,
• Doxy/Tetra
• Floroquinolones

Question 4

Coverage for anaerobics

Answer 4

Carbepenems- double coverage
Metro and clinda- classicanaerobics
Amoxicillin plust beta lactamases covers anaerobes

2nd gen cephalosporins- but no others (dont use cephalosporin for negs)

Question 5

B lactam allergy

Answer 5

Aztreonam (monobactam) doesnt usually cross react.

Question 7

Inpatient- non-ICU CAP

Answer 7

B lactam w/ macrolide (IV ceftriaxone and Azithro)
or
AntipneumpoFQ (levoquin, moxfloxacin)

Question 8

Inpatient ICU CAP

Answer 8

B-lactam + Macrolide or Antipneumo FQ
or
Aztreonam+ antipneumococcal FQ

Question 9

Inpatient risk for pseudomonas with CAP?

Answer 9

Use : PipTazo, Cefipime, or meropenum PLUS anti pseudomonal FQ- CIPRO

Might need clinda if also aspiration and you used cefapime. (Mero and piptazo cover it)

Question 10

If afraid maybe MRSA CAP?

Answer 10

ADD IV Vanco? Linezolid? (gram pos
only)

Vanco has renal tox
Linezolid cant be given with psych syndromes.

Question 11

MSSA

Answer 11

First gen cephalosporins like Nafcillin and cefazolin

Question 12

Pneumococcus pneumonia

Answer 12

Cefotaxime peds- adultsceftriaxone.

Question 13

Macrolides

Answer 13

Clarithro, Azythromycin

Broad spectrum also get atypicals- mycoplasma, chlamydia, legionella

Question 14

Tetracyclines

Answer 14

tetra, doxxy, mino

Broad coverage pos and negative- also atypicals

Question 15

Dapto

Answer 15

DO NOT USE IT IN PNEUMONIA- bound by surfactant.

can be used for abscess and septic emboi

Question 16

CAP treatent

Answer 16

5 days minimum, make sure afebrile for 48 hrs and no need for O2

If coag pos strep or pseudomonas treat 2 wks.

Question 17

HCAP criteria

Answer 17

>5 day hospitalization
>2 day hospitalization within 90 days
Nursing home, 
Recent IV antibiotics, chemo, or wound care
Dialysis within 30 days
Family member with MDR

Question 18

HCAP treatment with no MDR organisms

Answer 18

Ceftriaxone
Ertapemem
Levo/Moxi

Question 19

HCAP W risk for MDROs

Answer 19

PipTazo, Cefipime, Meropenim (pseudomonal Blactam)
or
Cipro
or
Genta/tobr/kano +linezolid or Vanco if MRSA possible

Question 20

CURB 65 criteria

Answer 20

Confusion
BUN>19
RR>30
BP 65

Home if 1 or less
2- maybe inpatient
3 or above, ICU

Question 21

PCN resistant Strep pneumo

Answer 21

*succeptable- Penicillin g or amox
*resistant 0.12.0 mcg/ml
Vanco +- rrifampin (if non meningial can do cefotaxime, high dose amp, carbepenims, FQ)

MDR-
Vanco +- rifampin
or clinda, levo, moxi
Linezolid

Question 24

Outpatient CAP

Answer 24

Previously healthy?
* Macrolide (Azythromycin, clarithromycin) 
or
* Doxycycline
Co-Morbidities
* Antipneumococcal FQ- Moxifloxacin or levofoxacin
or
*B-lactam + macrolide