Antibiotics for Respiratory Infections

Question 1

Antibiotic of choice:

Outpt–Previously healthy

Answer 1

Macrolide

Doxycycline

Question 2

Antibiotic of choice:

Outpt–Comorbidities

Answer 2

anti-pneumococcal FQ

beta-lactam plus macrolide

Question 3

Antibiotic of choice:

Inpt (non ICU), No PCN allergy

Answer 3

Beta-lactam plus macrolide

Question 4

Antibiotic of choice:

Inpt (non ICU), PCN allergy

Answer 4

anti-pneumococcal FQ

Question 5

Antibiotic of choice:

Inpt (ICU), No PCN allergy

Answer 5

Beta-lactam plus macrolide
OR
anti-pneumococcal FQ

Question 6

Antibiotic of choice:

Inpt (ICU), PCN allergy

Answer 6

anti-penumococcal FQ plus Aztreonam

Question 7

Inpt Rx if Pseudomonas is a consideration

Answer 7

An anti-pneumococcal, anti-pseudomonal beta-lactam (piperacillin-tazobactam, cefepime or meropenem) PLUS an anti-pseudomonal FQ

Question 8

If MRSA suspected

Answer 8

Add Vancomycin or Linezolid

Question 9

If aspiration suspected

Answer 9

Add Clindamycin to cover oral anaerobes (if initial regimen does not cover anaerobes)

Question 10

Classes of beta lactams

Answer 10

Penicillins
Cephalosporins
Carbapenems 
Monobactams
Beta-lactamas inhibitors

Question 11

Macrolides

Answer 11

Erythromycin
Clarithromycin
Azithromycin

Question 12

Fluoroquinolones

Answer 12

Anti-pneumococcal: Moxifloxacin, Levofloxacin

Anti-pseudomonal: Ciprofloxacin, Levofloxacin

Question 13

Tetracyclines

Answer 13

Tetracycline
Doxycycline
Minocycline

Question 14

Drugs for resistant Gram + bacteria

Answer 14

Vancomycin
Linezolid
Daptomycin

Question 15

What are some of the risk factors for MDROs in health care associated pneumonia?

Answer 15

Current hospitalization at least 5 days
Hospitalization in an acute care hospital for at least 2 days within the last 90 days
Residents of nursing home or long term care facility
Recipients of recent IV abx therapy, chemo or wound care in the last 30 days
Chronic dialysis within 30 days
Family member with MDR pathogen

Question 16

What is the therapy for someone with risk factors for MDROs in HCAP?

Answer 16

Broad spectrum Abx therapy:

Anti-pseudomonal betal lactam PLUS anti-pseudomonal FQ OR aminoglycoside PLUS Vancomycin or Linezolid if MRSA suspected

Question 17

What if someone does not have MDRO risk factors but has HCAP?

Answer 17

Treatment is Ceftriaxone
OR Amp/Sulbactam
OR Ertapenem
OR FQ

Question 18

What are some risk factors for PRSP (Penicillin resistant Streptococcus pneumonia)

Answer 18

Age > 65
Beta lactam therapy in the past 3 months
Alcoholism 
Multiple medical comorbidities (immunosuppressive illness or medications) 
Exposure to a child in a day care center

Question 19

If PRSP– 0.1 < MIC < 1.0

Answer 19

high dose penicillin G or ampicillin

Cefotaxime/Ceftriaxone

Question 20

If PRSP– MIC > 2.0

Answer 20

Vancomycin +/- Rifampin
High dose Cefotaxime tired in meningitis
Non-meningeal infection: cefotaxime/ceftriaxone, high dose ampicillin, carbapenems, or fluoroquinolone

Question 21

MDRSP (multidrug resistant) = resistant to any 2 of the following: penicillins, erythromycin, tetracycline, macrolides, cotrimoxazole

Answer 21

Vancomycin +/- Rifampin
Clindamycin, Levofloxacin, Moxifloxacin
Linezolid