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
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
3
Q
CAP TX for healthy adult
A
- macrolides (level I)-azithromycin, clarithromycin, erythromycin
- doxycycline if allergic
- tx for at least 5 days
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
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
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
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
8
Q
pneumonia in children
A
- 4-6 wks old-possible chlamydia
- 5-adolescence-possible mycoplasma
- most commonly s.pneumonia
- CA-MRSA,and virus
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