Chapter 42 pneumonia Flashcards

1
Q

Common adult pathogens

A
  • s.pneumoniae
  • pt with underlying lung dz-haemophilus influenza, morganella catarrhalis
  • staph aureus: co-pathogen with influenza
  • mycoplasma pneumoniae
  • viral pneumonia
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2
Q

CAP levels

A

I: previously healthy, no risk factors for drug resistance to s.pneumonia
II: patients with risk factors
III: not admitted to ICU
IV: admitted to ICU

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3
Q

CAP TX for healthy adult

A
  • macrolides (level I)-azithromycin, clarithromycin, erythromycin
  • doxycycline if allergic
  • tx for at least 5 days
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4
Q

Pathiphysiology

A
  • organism invades lung parenchyma and host defenses depressed
  • bacterial pneumonia occurs when lung’s primary defenses are altered either by viral infection or immunologic problems
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5
Q

CAP tx for level II

A
  • respiratory fluoroquinolones (moxifloxacin, gemifloxacin, levofloxacin)
  • beta lactam PLUS macrolide (amoxicillin, amoxicillian/clavulanate, cefpodoxime, cefurosime….)
  • doxycycline may be used as substitute for macrolide
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6
Q

CAP tx for pt>60 yrs with comorbities

A
  • outpatient option:
  • ceftriaxone (Rocephin) 1g daily IV/IM or levofloxin 500 mg IV daily
  • switch to oral once pt can tolerate
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7
Q

CAP in pregnant women

A

-macrolide choices: cat B-erythromycin, azithromycin
Cat C: clarithromycin
-if comorbities or recent abx: beta lactam PLUS macrolide

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8
Q

pneumonia in children

A
  • 4-6 wks old-possible chlamydia
  • 5-adolescence-possible mycoplasma
  • most commonly s.pneumonia
  • CA-MRSA,and virus
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9
Q

pediatric abx choices

A

5yrs old

- erythromycin 40-50 mg/kg/day-usually loading dose than decrease
- azithromycin 10mg/kg day 1; 5mg/kg day on days 2-5
- clarithromycin 15 mg/kg per day in 2 doses
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