Caldwell Lecture Objectives

Question 1

level I vs. level III evidence; which is better?

Answer 1

• level I = evidence from at least one properly designed randomized, controlled trial
• level II = opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees
• obviously level I is better

Question 2

1 class or 3 specific abx w/ level I evidence vs. strep pneumo in outpatient setting w/ no risk factors

Answer 2

• macrolide –> azithromycin, clarithromycin, or erythromycin

Question 3

monotherapy and combo therapy w/ level I evidence for tx of non-ICU CAP

Answer 3

• monotherapy = respiratory fluoroquinolones
• beta-lactam + macrolide
• in pen-allergic pts –> use fluoroquinolones

Question 4

apply category of abx w/ level I evidence of effectiveness for CAP in the ICU

Answer 4

• respiratory fluoroquinolones (level I)
• beta-lactams + azithromycin (level II)
• in pen-allergic pts –> fluoroquinolones + aztreonam

Question 5

for pseudomonas CAP in the ICU

Answer 5

1. beta-lactam + ciprofloxacin OR levofloxacin
2. beta-lactam + tobramycin OR gentamicin + azithromycin
3. beta-lactam + tobramycin OR gentamicin + respiratory fluoroquinolone