Bronchitis and Pneumonia Flashcards
only bacterial cause of AB (Acute Bronchitis) responds to abx
B. pertussis
AB is febrile or afebrile?
afebrile unless etiology is flu
rhonchi in AB
clears with coughing , no rales
procalcitonin
elevated in bacterial infection, drop of 80% =>d/c abx
management of AB
symptomatic, OTC, antitussives, beta 2 agonists
abx needed for AB?
no but 60-90% are given. educate pts
1 cause of transmission of pneumonia
aspiration from oropharynx
classification of Pneumonia
CAP, HAP, VAP, HCAP
most common cause of CAP
s. pneumo
clinical signs of CAP-general
fever, RR>24, Tachycardia, rales, consolidation
clinical signs of CAP-atypical
confusion, weakness, FTT, delirium, abd pain, tachypnea, HA, N/V/D, myalgia/arthralgia
Dx labs for CAP
leukocytosis (15-30) with left shift
Dx CXR for CAP
infiltrate /consolidation
types of consolidation in CAP
lobar, interstitial, cavitation (straight line)
CURB 65
confusion, urea>7, RR>30, BP, >65
ICU
3-5 on CURB65
Admit
2 on CURB65
out pt
0-1 on CURB65
CAP tx: healthy no abx use w/in past 3 months
macrolide/doxycycline
CAP tx: macrolide resistant/abx use w/in 3 months
respiratory fluroquinolone/betalactam+macrolide
first line beta lactam
high dose amoxicilin/ amoxicilin-clavulanate
alternative to beta lactam
ceftriaxone, cefpodoxime, cefuroxime
CAP-inpt-nonICU tx
respiratory fluoroquinolone/ anti-pneumoccocal beta lactam+macrolide
CAP-ICU tx
anti-pneumococcal beta lactam + azithromycin/ anti-pneumococcal beta lactam + resp. fluoroquinolone/ resp. fluoroquinolone+ aztreonam
CAP tx Pen allergy
resp. fluoroquinolone+ aztreonam
CAP ICU w/ pseudomonas risk
Antipneumococcal, antipseudomonal beta lactam + either ciprofloxacin or levofloxacin/ above beta-lactam+ an aminoglycoside + azithromycin/ above beta-lactam + an aminoglycoside + a respiratory fluoroquinolone
CAP ICU w/MRSA
add vancomysin or linezolid
pathophysiology for HAP, VAP, HCAP
altered upper respiratory tract flora: pharyngeal colonization
Dx for HAP, VAP, HCAP
new or progressive infiltrate on lung imaging + 2 of (fever, purulent sputum, leukocytosis)
sputum gram stain and culture are indicated for ?
HAP, VAP, HCAP
are considered at risk for drug resistance
HCAP
what has long duration of tx? (14-21 days)
pseudomonas aeroginosa
Tx of HAP, VAP, HCAP
Antipneumococcal, antipseudomonal beta lactam + respiratory fluoroquinolone + vancomycin/linezolid
monotherapy can be used for HAP/VAP if
no resistent pathogen
prevention of VAP
no acid-blocking meds, decontamination of oropharynx and gut, probiotics, positioning (not supine) , subglottic drainage
common cause of viral CAP
flu=>secondary bacterial common (staph)
fungal pneumonias
Histoplasmosis,
Blastomycosis,
Coccidiodomycosis
pneumonia a/w HIV
Pneumocystis jirovecii pneumonia
what is the most common symptoms of Pneumocystis jirovecii pneumonia?
fever, cough, progressive dyspnea
test results for Pneumocystis jirovecii pneumonia?
high LDH and low CD4
tx of Pneumocystis jirovecii pneumonia?
bactrim
common cause of aspiration pneumonia
G- and anaerobic
risk factors for aspiration pneumonia
post op, neurologic compromise, anatomical defect
common site of aspiration pneumonia
RLL
abx for aspiration pneumonia
Piperacillin/tazobactam or ampicillin/sulbactam; or Clindamycin; or moxifloxacin
