Bacterial Infections of the Lung Flashcards by Shane Hagen

Pneumonia is infection of what part of the RT?

lower (respiratory bronchioles, alveoli)

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What are the symptoms of pneumonia?

FEVER, cough, and sputum production
Dyspnea
Chest infiltrates

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THE most important factor in successful pneumonia treatment is what?

EARLY intervention, cultures from blood and sputum to

identify the infective organism can be obtained after beginning broad, empiric treatment

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What is the most likely cause of community acquired pneumonia (CAP) in patients 0-6 weeks of age?

Group B strep or E. Coli

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What is the most likely cause of community acquired pneumonia (CAP) in patients 6 weeks to 18 years of age?

Viruses, Mycoplasma pneumoniae, Chlamydia pneumoniae,

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What is the most likely cause of community acquired pneumonia (CAP) in patients 18-40 years of age?

Mycoplasma pneumoniae, Strep pneumo

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What is the most likely cause of community acquired pneumonia (CAP) in patients 40-65 years of age?

Strep pneumo, Haemophilus influenzae, anaerobes and viruses,

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What is the most likely cause of community acquired pneumonia (CAP) in patients over 65 years of age?

Strep pneumo, viruses, anaerobes

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What is the most likely cause of nosocomial pneumonia?

Staph aureus or Pseudomonas aeruginosa

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Alcohol use attenuates lung function. How?

Chronic alcohol drinkers have decreased

saliva production, an important component of mucosal defense.

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Diabetes also increases the risk of pneumonia. How?

Possibly because the disorder neutralizes the effects of protective proteins on the surface of
the lungs.

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What is the most likely cause of pneumonia in diabetics or alcoholics?

Klebsiella

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Immunodeficient patients are at risk of infection from what organisms?

- Aspergillus and Pneumocystis

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Describe Legionalle Pneumophilia

a gram negative aerobe that thrives in aquatic environment and loves water between 25-42 C

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What patient population is most at risk for pneumonia caused by legionella (Legionnaires Disease)?

Men over 50
Smokers or those with COPD
Immunocompromised

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What is commonly used to treat legionnaires pneumonia?

erythromycin
azithromycin
“respiratory” quinolone”

These drugs have good dosing characteristics and the advantage of easily
achieving good conc. in pulmonary tissues.

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What are some ‘respiratory’ quinolones?

-levofloxacin, cipro, or moxifloxacin

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What is a major possible DD interaction in patients taking macrolides?

rifampin

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What is the DOC for outpatient CAPs with no modifying factors?

any macrolide or doxycycline

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What is the DOC for outpatient CAPs with COPD who HAVE taken steroids or antibiotics in the past 3 months ?

Fluoroquinolone or amox/clav or clarithromycin +- cephalosporin

same for a nursing home patient

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What is the DOC for outpatient CAPs with COPD who HAVE NOT taken steroids or antibiotics in the past 3 months ?

clarithromycin or doxycycline

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What is the DOC for hospital ward CAPs?

fluroquinoline or amox/clav or clarithro/azithromycin +- cephalosporin

What is the DOC for ICU CAPs?

3rd gen cephalosporin +- macrolide or piperacillin/tazo or fluoroquinolone

What is the DOC for ICU CAPs with a risk of P. aeruginosa?

ciprofloxacin + B-lactam OR

macrolide + (amino, ceftazidime, cefepime, meropenem, or piper/taz)

In nocosomial pneumonia, vanco is reserved for what?

MRSA

Gram+ cocci being the cause of nocosomial pneumonia is more common in what patients?

- ICU - DM - Head trauma

What are the DOC for nocosomial pneumonia?

- Imipenem/Cilastin - Aztreonam - Ceftazidime (Cefepime) - Vanco (poor bioavailability, give IV)

What is aspiration pneumonia?

When aspiration of gastric acid, a foreign body or normal oropharyngeal secretions give rise to pneumonia

When are oropharyngeal secretions most likely to cause aspiration pneumonia?

in reduced consciousness and long term intubation

Most of the causative organisms for aspiration pneumonia are ____

gram negative enteric bacilli (50%), then anaerobes and S. aureus

What is the DOC for aspiration pneumonia?

clindamycin or ampicillin/sulbactam

How does clindamycin work?

50s ribosomal inhibitor blocking translocation

What are some situations in which PO administration would not be best?

- presence of food or other chelating drugs in GI | - Hypotension shunts blood away from GI

What does 'concentration dependence' mean in terms of drugs?

bacterial death is proportional to conc (i.e. fluoroquinolone or aminoglycosides), whereas time-dependent antibiotics are dependent on duration in serum (B-lactams)

How are conc dependent drugs given?

these are often given in large doses (relative to the MIC) at long intervals relative to the serum half life for the agent.

How are time dependent antibiotics given?

usually dosed more frequently, with an emphasis on the need to maintain the serum drug level above the MIC for 30-50% of the dose interval.

Which drugs are not predominantly renally eliminated?

- azithromycin/erythromycin - ceftriaxone - clindamycin - doxycycline - linezolid

What are some AEs of doxycycline?

- teeth discolorization - photosensitivity - stunted bone growth

What are some AEs of vance?

nephro and ototoxicity and Red Man's syndrome

What are some AEs of levofloxacin?

-tendon rupture in adults and cartilage damage in young children

What are some AEs of erythromycin?

- CYP3A4/Pgp inhibitor - Jaundice - QT prolongation

What are some AEs of gentamicin?

nephro and ototoxicity and neuromuscular paralysis

What are some AEs of linezolid?

- bone marrow suppression | - non-specific MAO inhibitor

What is the rational of adding clavulanic acid to amoxicillin, tazobactam to piperacillin, and sulbactam to ampicillin?

the are irreversible inhibitors of bacterial beta-lactamases

Why is cilastin given with Imipenem?

it is a reversible, competitive inhibitor of renal dehydroepeptidase-1 (DHP-1), which breaks down Imipenem to NEPHROtoxic metabolites

Why is Daptomycin not used to treat pneumonia even though it has greater activity than vance vs. some gram positive organisms?

The drug activity is directly inhibited by the presence of pulmonary surfactants.

What are the most common causes of bronchitis in young patients?

viral

What is the most common causes of bronchitis in smokers?

H. influenzae

What is the most common causes of bronchitis in elderly patients with comorbidites?

bacterial (mycoplasma pneumoniae, Strep pneumo, H. influenzae)

DOC for bronchitis?

- amoxi/clav - azithro/clarithro - doxycycline

DOC for resistant bronchitis?

Cipro

How is lung abscess treated?

Treatment initially involves IV drug therapy with transition to an 2 month oral regimen after a couple of weeks.

DOC for lung abscess?

Although penicillin has been considered as the drug of choice, clindamycin has proven superior, primarily because of the emergence of penicillin-resistant Bacteroides.

Other drug choices for lung abscess?

Metronidazole should not be used alone due to incomplete coverage, but may be used with a third generation cephalosporin for nocosomial infection