Bacterial Pneumonia

Question 1

Pneumonia

Answer 1

Pneumonia is defined as inflammation of the lung parenchyma of infective origin and characterized by consolidation

Question 2

Consolidation

Answer 2

Consolidation is a pathological process in which the alveoli
are filled with a mixture of inflammatory exudate, bacteria
and white blood cells

Question 3

Consolidation on chest X-ray appear as an _________ shadow

Answer 3

opaque

Question 4

Classification of pneumonia

Answer 4

•community-acquired pneumonia (CAP)(within 48 hrs of hospital admission)
•hospital-acquired pneumonia (HAP).
•ventilation-acquired pneumonia
•healthcare associated pneumonia

Question 5

Which of the following microrganism constitute about 60% of all CAP cases?

A.Haemophilus influenzae
B.Legionella pneumophilia
C.Chylamydophilia pneumoniae
D.Streptococcus pneumoniae

Answer 5

D

Question 6

Common Causes of infectious pneumonia Bacteria;

Answer 6

•Streptococcus pneumonia(Most common)
•Mycoplasma pneumonia,
•chlamydia pneumonia,
•Mixed anaerobes –Aspiration pneumonia Khlebsiela (Most common gram negative)

Question 7

Risk factors

Answer 7

 Cigarette smocking
 Recent viral respiratory infection-a cold,laryngitis,influenza e.t.c.
 Presence of chronic lung diseases such as COPD, Bronchietasis or cystic fibrosis
 Stroke
Very young(<5 years) and the elderly(>70 years)  Alcoholics/cirrhosis
Renal/cardiac diseases

Question 8

Clinical features

Answer 8

Systemic signs and symptoms
Fever Rigors Sweats Malaise Anorexia Fatigue

II. Focal signs and symptoms
Productive cough Purulent sputum Pleuritic chest pain

Question 9

Investigations

Answer 9

General
Chest X –ray, full blood count, urea, electrolytes, liver function tests, C – reactive protein, oxygen saturation and arterial blood gases assessment.

• Microbiological
• Blood culture, sputum culture and sensitivity.
• Specific investigations for Legionella and chlamydia may be requested depending on the severity and history.

Question 10

Causative organism is not identified in approximately 40% of sputum samples taken in patients in _____.

Answer 10

CAP

Question 11

BTS recommends the use of CURB - 65 model as a means of predicting _______ and hence stratifying patients onto ________ ________ ________.

Answer 11

BTS recommends the use of CURB - 65 model as a means of predicting mortality and hence stratifying patients onto different treatment pathways.

Question 12

CURB – 65 SEVERITY ASSESSMENT MODEL

Answer 12

• Assign one point for each of the following:
• Confusion (new disorientation in person, place or time)
• Uraemia > 7mmol/l (19 mg/dl)
• Respiratory rate ≥ 30/min
• Blood pressure: Systolic < 90mmHg, Diastolic ≤ 60mmHg (1point each)
• Age ≥ 65 years

Question 13

Notes on the drugs

Answer 13

• Penicillins
I. These are bactericidal ,they kill organisms by blocking their cell wall, for patients allergic to penicillin, macrolides would be considered
II. Macrolides
These block the bacterial protein synthesis and they are bacteriostatic agents

Question 14

SIDE EFFECTS

Answer 14

• Penicillin
a. Watch out for hypersensitivity reactions b. Pseudomembranous colitis
Macrolides & Fluoroquinolones
a. QT prolongation, watch out in elderly and patients with heart failure

Question 15

Streptococcus pneumonia

Answer 15

First-Line Treatment:
• Penicillin-Susceptible Strains: Amoxicillin 1 g orally three times daily
or Penicillin G 1-2 million units IV every 4-6 hours.
• Penicillin-Resistant Strains: Ceftriaxone 1-2 g IV once daily or Cefotaxime 1-2 g IV every 8 hours.
• Alternative: Levofloxacin 750 mg orally or IV once daily, or Moxifloxacin 400 mg orally or IV once daily.
Duration: 5-7 days, depending on clinical response.

Question 16

Haemophilus influenza

Answer 16

First-Line Treatment:
Amoxicillin-Clavulanate 875 mg/125 mg orally twice daily or 1 g/125 mg orally twice daily.
• Alternative: Cefuroxime 500 mg orally twice daily or Azithromycin 500 mg orally on day 1, then 250 mg daily on days 2-5.
• Beta-Lactamase Positive Strains: Use Amoxicillin-Clavulanate or Cefuroxime as above.
• Duration: 5-7 days.

Question 17

Moraxella catarrhalis

Answer 17

First-Line Treatment:
• Amoxicillin-Clavulanate Dosage: 875 mg/125 mg orally twice daily or
1 g/125 mg orally twice daily.
• Second- or Third-Generation Cephalosporins
• Macrolide e.g Azithromycin
• Flouroquinolones e.g Levoflo, Moxiflo
• Alternative = Doxycycline 100 mg bd
• Duration of therapy 7-14 days

Question 18

Pseudomonas aeruginosa

Answer 18

First-Line Treatment:
Piperacillin-Tazobactam 4.5 g IV every 6 hours or Cefepime 2 g IV every
8 hours.
• Alternative: Meropenem 1 g IV every 8 hours or Imipenem-Cilastatin 500 mg IV every 6 hours.
• For critically ill patients: Consider combination therapy with an aminoglycoside (e.g., Tobramycin or Amikacin) or a fluoroquinolone (e.g., Ciprofloxacin).
• Duration: 7-14 days, up to 21 days for severe infections

Question 19

Legionella pneumophila

Answer 19

First-Line Treatment:
Levofloxacin 750 mg orally or IV once daily or Moxifloxacin 400 mg
orally or IV once daily.
• Alternative: Azithromycin 500 mg IV or orally once daily.
• Severe Cases: Combination therapy with Levofloxacin plus Azithromycin may be used.
• Duration: 7-14 days, up to 21 days for severe cases.

Question 20

Klebsiella pneumonia

Answer 20

First-Line Treatment:
Ceftriaxone 1-2 g IV once daily or Cefotaxime 1-2 g IV every 8 hours.
• Alternative: Levofloxacin 750 mg orally or IV once daily or Piperacillin-Tazobactam 4.5 g IV every 6 hours.
• Extended-Spectrum Beta-Lactamase (ESBL) Producing Strains: Carbapenems: Meropenem 1 g IV every 8 hours or Imipenem-
Cilastatin 500 mg IV every 6 hours. • Duration: 7-14 days.

Question 21

Staphylococcus aureus

Answer 21

Methicillin-Sensitive Staphylococcus aureus (MSSA):
First-Line Treatment: Nafcillin or Oxacillin 2 g IV every 4-6 hours.
Alternative: Cefazolin 1-2 g IV every 8 hours or Clindamycin 600 mg IV every 8 hours (for penicillin-allergic patients).
• Methicillin-Resistant Staphylococcus aureus (MRSA): First-Line Treatment:
Vancomycin 15-20 mg/kg IV every 8-12 hours, adjusted based on serum levels.
• Alternative: Linezolid 600 mg orally or IV every 12 hours. • Duration: 7-14 days, depending on clinical response.

Question 22

Mycoplasma pneumoniae and Chlamydia pneumoniae

Answer 22

First-Line Treatment:
• Azithromycin 500 mg orally on day 1, then 250 mg once daily on days 2-5. • Alternative: Doxycycline 100 mg orally twice daily for 7-14 days or
Levofloxacin 750 mg orally or IV once daily for 5 days.
• Duration: 7-14 days, depending on clinical response and severity.

Question 23

RESPIRATORY VIRUSES (e.g., Influenza, RSV, SARS-CoV-2)

Answer 23

Influenza:
First-Line Treatment: Oseltamivir 75 mg orally twice daily for 5 days. Alternative: Zanamivir 10 mg (two inhalations) twice daily for 5 days.
• RSV (Respiratory Syncytial Virus):
Ribavirin is sometimes used in severe cases or for immunocompromised patients.

• SARS-CoV-2:
• Antivirals: Remdesivir 200 mg IV on day 1, then 100 mg IV daily for 5-
10 days. Paxlovid® (Nirmatrelvir/r) 500 mg tds.
• Supportive Care: Oxygen therapy, corticosteroids (e.g., Dexamethasone 6 mg daily for up to 10 days).

Question 24

FUNGAL PNEUMONIA

Answer 24

• Aspergillus spp.
• First-Line Treatment:
• Voriconazole 6 mg/kg IV every 12 hours on day 1, then 4 mg/kg IV every 12 hours (or 200 mg orally every 12 hours).
• Alternative: Liposomal Amphotericin B 3-5 mg/kg IV daily

Question 25

MONITORING

Answer 25

Temperature, respiratory rate, pulse,
blood pressure,
oxygen saturation and
C-reactive protein(CRP) to fall at least by 50% after 4 days of treatment.

Question 26

CURB-65 scoring

Answer 26

SCORING:
• 0-1: Low risk – consider outpatient treatment
• 2: Moderate risk – consider short inpatient stay or OPD with close follow- up
• 3-5: High risk – typically requires hospitalization, and potentially ICU admission depending on the score

Question 27

Anti-MRSA cephalosporins (v)

Answer 27

• Ceftaroline
• Ceftobiprole

Question 28

Antipseudomonal cepha (iv)

Answer 28

• Ceftazidime
• Ceftazidime/avibactam
• Ceftolozane/tazobactam
• Cefepime