CAP Flashcards
Duration of therapy in treatment of Community Acquired Pneumonia
Minimum treatment at least 5 days
Afebrile for 48-72 hours
Procalcitonin can guide abx cessation
No more than one CAP associated sign of instability (low BP, low O2, high RR, high HR)
Indications (8) for sputum cultures in diagnosis of Community Acquired Pneumonia
ICU/severe pneumonia
Prior hospital stay
Abx in last 90 days/abx failures
Cavitary lesions
Alcohol use
Severe obstructive lung disease
Pleural effusion
Positive urine for pneumococcus or legionella
Prevention of Community Acquired Pneumonia
PREVNAR-20
Flu vaccine (all patients 6 months or older get yearly, high dose if 65+)
Antibiotics (3) selection in treatment of Community Acquired Pneumonia patient who is inpatient, without MRSA or pseudomonas
IV B-lactam + macrolide
Fluroquinolone
IV B-lactam + doxycycline (if fluoroquinolone or macrolide allergy)
On chest x-ray you see bilateral lower lobe infiltrates in a patient with Community Acquired Pneumonia patient. What do you suspect is causing this patient’s conidition?
Mycoplasma
MRSA risk factors (3)
Recent influenza
Fluoroquinolones in previous 30-60 days
Cramped living conditions/contact sports
True or false. Sputum cultures are routinely recommended for diagnosis of Community Acquired Pneumonia
False
True or false. Blood cultures are routinely recommended in the diagnosis of Community Acquired Pneumonia
False. But can be helpful in critically ill
When are urine antigen tests indicated in Community Acquired Pneumonia, and what might they detect?
Indicated in severe CAP
Used to detect s. pneumoniae and legionella
Diagnosis for Community Acquired Pneumonia
GOLD STANDARD = Chest x-ray (PA + lateral)
If negative C-XR with high suspicion either:
- Get CT for better visibility
- Repeat C-XR after 24 hours
Antibiotics (2) selections in treatment of a Community Acquired Pneumonia patient with DRSP risk factors and is outpatient
B-lactam (augmentin or ceph) + doxycycline or macrolide
Fluoroquinolone (levo or moxifloxacin)
Community Acquired Pneumonia symptoms
Pleuritic chest pain that is focal and with inspiration
Cough, fever, chills, dyspnea, sputum production
Describe methods used to classify the severity of Community Acquired Pneumonia
PSI score: More sensitive, better for high risk patients, complex (let EHR do it)
CURB-65: More specific
- Confusion
- Uremia (BUN >20)
- Resp rate (>30)
- Blood pressure (<90/60)
- 65+ years old
Antibiotics (3) selection in treatment of Community Acquired Pneumonia patient who is healthy, without DRSP risk factors, and is outpatient
Amoxicillin
Doxycycline
Macrolides (azithromycin good because anti-inflammatory)
Antibiotics selection in treatment of Community Acquired Pneumonia patient who is inpatient, with risk for MRSA or pseudomonas
B-lactam
+
Azithromycin OR fluoroquinolone
+
IV linezolid OR IV vancomycin
