abx (rti) Flashcards
pharyngitis, CAP,HAP,VAP
pharyngitis bacteria, first line
streptococcus pyogene (gram pos), amoxicillin
GOT of pharyngitis
- Reducing symptom severity and duration
- Prevention of acute complications, such as otitis media,
peritonsillar abscesses, or other invasive infections - Prevention of delayed complications or immune sequelae, particularly acute rheumatic fever
- Prevention of spread to others (no longer infectious after 24
hours of antibiotics)
modified centor criteria
- Fever > 38
- Swollen, tender anterior cervical lymph nodes
- Tonsillar exudate
- Absence of cough
- Age:
3 – 14 years (+1)
15 – 44 years (0)
45 years or older (-1)
rhinosinusitis pathogen, first line
Streptococcus pneumoniae
Haemophilus influenzae
(gram neg)
augmentin
differential diagnoses of rti
bronchitis, pneumonia, acute asthma, or an exacerbation of COPD
acute bronchitis cough advice
Patients with acute bronchitis should be told that their cough
may last for at least 3 weeks and that antibiotics will not hasten
resolution of the cough.
risk factors of pneumonia
smoking, chronic lung conditions (eg asthma, copd), immunosuppression
lung auscultation for pneumonia
- Diminished breath sounds over the affected area
- Inspiratory crackles during lung expansion
symptoms of pneumonia
- Cough, chest pains, shortness of breath, tachypnoea, hypoxia
- Increased sputum production
cxr finding pneumonia
evidence of a new
infiltrates or dense consolidations
urinary antigens in pneumonia
Streptococcus pneumonia
y Legionella pneumophilia
when are urinary tests recommended for pneumonia?
severe CAP or hospitalized patients
what is CAP
Onset in the community or < 48
hours after hospital admission
what is HAP
Onset ≥ 48 hours after hospital
admission
what is VAP
Onset ≥ 48 hours after mechanical
ventilation
CAP outpatient pneumonia pathogens (no comorb)
tx?
Streptococcus pneumoniae
amox or FQL
CAP
- outpatient comorb
- inpatient pathogens non severe
s.pneumoniae, h influenzae + atypicals
beta lactam +
macrolide/doxy
OR
FQL
CAP if inpatient non severe but have risk factors for MRSA
linezolid, vanco
what are macrolides/doxycycline often used for
covering atypicals
why do we avoid cipro in CAP/VAP/HAP
does not cover s.pneumoniae
CAP inpatient pathogens severe
outpatient
s.aureus
atypicals
klebsiella pneumoniae
BULKHOLDERIA PSEUDOMALLEI
CAP inpatient severe tx
beta‐lactam (amoxicillin/clavulanate OR Penicillin G)
+
Ceftazidime (pseudomonas)
+
Macrolide (atypical)
OR
Respiratory FQ (levofloxacin OR moxifloxacin)
Ceftazidime (bulkholderia)
what is CURB 65
Confusion (new onset) 1
Urea > 7 mmol/L 1
RR ≥ 30 breaths/min 1
Blood Pressure: Low
Age ≥ 65 years
≥3: consider ICU admission
uses of PO vanco
only cdad
risk factors for MRSA
▪Resp isolation of MRSA in last 1 year
▪Hospitalisation or parenteral antibiotic use in last 90 days AND MRSA PCR screen
positive
risk factors for p aeru
▪Resp isolation of P. aeruginosa in last 1 year
which fql covers for pseudomonas
levoflox, ciproflox (but increasing resistance)
anti pseudomonal agents
Piperacillin/tazobactam, Ceftazidime, Cefepime,
Meropenem, Levofloxacin
if lung abscess and empyema (pus collection), what additional coverage
anaerobes
metronidazole / clindamycin
adverse effects of fqls
tendonitis, tendon rupture, neuropathy, QTc
prolongation, CNS disturbances, hypoglycemia
CAP treatment duration
5d, 7d if MRSA/p.aeruginosa
CAP need to repeat microbio test or cxr?
no unless clinical deterioration
healthcare related risk factors for HAP/VAP
Healthcare‐related factors
▪ Prior antibiotic use
▪ Sedatives
▪ Opioid analgesics
▪ Mechanical ventilation
▪ Supine position
minimum coverage for HAP/VAP
pseudomonas, s. aureus
when to cover MRSA if VAP/HAP
- prior intravenous antibiotic use within 90 days
- isolation of MRSA in last 1 year
- hospitalization in a unit where >20% of S. aureus are MRSA
- patient is
at high risk for mortality (ie need for ventilatory support due
to HAP and septic shock)
when to cover pseudomonas in hap/vap
USE 2 AGENTS OF DIFF CLASSES
- risk factor for antimicrobial resistance (prior intravenous
antibiotic use within 90 d; acute renal replacement therapy
prior to VAP onset; isolation of P. aeruginosa in last 1 year) - hospitalization in a unit where >10% of Pseudomonas isolates
are resistant to an agent being considered for monotherapy - patient at high risk for
mortality (include need for ventilatory support due to HAP and septic shock)
why should you not given aminoglycoside more than a week
nephrotoxicity
carbapenem first line for what
ESBL / MDRO
does ceftazidime cover gram pos
no
monitoring parameters
heart rate, respiratory rate, blood
pressure, oxygen saturation, and temperature
tx dx for hap/vap
7d
