CAP

Question 1

outpatient microbiology for CAP

Answer 1

S. pneumoniae
H. influenzae
Mycoplasma pneumoniae
Chlamydophila pneumoniae

Question 2

inpatient, non-severe microbiology for CAP

Answer 2

S. pneumoniae
H. influenzae
M. pneumoniae 
C. pneumoniae 
Legionella pneumophilia

Question 3

inpatient, severe microbiology for CAP

Answer 3

S. pneumoniae 
H. influenzae
M. pneumoniae 
C. pneumoniae 
L. pneumophilia 
S. aureus 
Klebsiella pneumonia
Burkholderia pseudomallei

Question 4

minor criteria for CAP

Answer 4

RR ≥ 30bpm 
PaO2/Fio2 ≤ 250
multilobar infiltrates 
confusion/disorientation 
uremia > 7mmol/L
leukopenia < 4x10^9 cells/L 
hypothermia < 36ºC 
hypotension requiring intensive fluid resuscitation

Question 5

major criteria for CAP

Answer 5

mechanical ventilation

septic shock requiring vasoactive interventions

Question 6

outpatient general population treatment for CAP

Answer 6

b-lactam: amoxicillin PO 1g TDS

OR
respiratory FQs: levofloxacin PO 750mg OD; moxifloxacin PO

Question 7

outpatient, chronic heart, lung, renal, liver diseases, DM, alcoholism, malignancy, asplenia treatment for CAP

Answer 7

B-lactam: amoxicillin/clavulanate po 625mg TDS or 2g BD; cefuroxime PO 500mg BD
PLUS
macrolide: clarithromycin PO 500mg BD; azithromycin PO 500mg OD or doxycycline PO 100mg BD

OR
respiratory FQs: levofloxacin PO 750mg OD

Question 8

inpatient, non-severe treatment for CAP

Answer 8

b-lactam: amoxicillin/clavulanate IV 1.2g Q8h; ceftriaxone IV 1-2g Q24h
PLUS
macrolide: clarithromycin IV 500mg Q12h; azithromycin IV 500mg Q24h or doxycycline PO 100mg BD

OR
respiratory FQs: levofloxacin IV 750mg Q24h

Question 9

inpatient, severe treatment for CAP

Answer 9

b-lactam: amoxicillin/clavulanate IV 1.2g Q8h PLUS ceftazidime IV 2g Q8h
PLUS
macrolides: clarithromycin IV 500mg Q12h; azithromycin IV 500mg Q24h or doxycycline PO 100mg BD

OR
respiratory FQs: levofloxacin IV 750mg Q24h; moxifloxacin IV
PLUS
ceftazidime IV 2g Q8h

Question 10

anaerobic coverage indication for CAP

Answer 10

microbiology: B. fragilis, Prevotella spp, Porphyromonas spp, Fusobacterium spp
indication (ANY):
lung abscesses
empyema

Question 11

anaerobic coverage treatment for CAP

Answer 11

Add on if no anaerobic coverage in existing therapy:
clindamycin IV/PO
metronidazole IV/PO

Question 12

MRSA indications for CAP

Answer 12

prior respiratory isolates of MRSA in past 1y

severe CAP: hospitalisation and received IV antibiotics within last 90d

Question 13

MRSA indication treatment for CAP

Answer 13

add on to standard treatment
vancomycin IV 15mg/kg Q8-12h
linezolid IV 600mg Q12h or PO

Question 14

pseudomonal coverage indications for CAP

Answer 14

prior respiratory isolates of P. aeruginosa in last 1y

Question 15

pseudomonal coverage treatment for CAP

Answer 15

modification of existing treatment to include coverage
piperacilin/tazobactam IV 4.5g Q6-8h
ceftazidime IV 2g Q8h 
cefepime IV 2g Q8h
meropenem IV 1g Q8h
levofloxacin IV/PO 750mg Q24h/OD

Question 16

clinical improvement, duration of treatment for CAP

Answer 16

48-72h
clinical stability achieved and for at least 5d
MRSA, P. aeruginosa: 7d
B. pseudomallei: 3-6m

Question 17

pathogenesis of CAP

Answer 17

aspiration of oropharyngeal secretions
inhalation of aerosols
hematogenous spreading

Question 18

stepdown from IV to PO in CAP

Answer 18

hemodynamically stable 
clinically improving/improved 
afebrile > 24h 
normally functioning GIT 
able to ingest PO