COMMUNITY ACQUIRED PNEUMONIA

Question 1

MANAGEMENT

Answer 1

OUTPATIENT ABX

Healthy Adult

First Line:
Amoxicillin 1 g PO tid

Second Line:
Azithromycin 500 mg PO day 1, 250 mg PO day 2 - 5
Cefuroxime 500 mg PO bid
Doxycycline 100 mg PO bid

Outpatient CAP txt in adult with modifiers/co morbidities or LTC:

First Line:
Amoxicillin 1 g PO tid
OR
Cefuroxime 500 mg PO bid
PLUS
Azithromycin 500 mg PO day 1, 250 mg PO day 2 - 5
OR
Doxycycline 100 mg PO bid
OR
Second Line:
* Fluroquinolone (Moxifloxacin, Gemifloxacin, Levofloxacin)–Not first line because partially treats TB

Empiric 5days
Normal range 7-14 days
respond within 72 hrs
discontinue abx if afebrile 48-72 hrs
no-repeat CXR in adults with resolved CAP 5-7 days
repeat in 6wks if extensive/comorbities

txt for CAP requiring hospitalization?
Ceftriaxone 1-2 g IV daily 7 d
PLUS
Azithromycin 500 mg IV daily 3 d
OR
Fluroquinolone (Levofloxacin, Moxifloxacin)

Consider 50mg / day prednisone or 40 mg / day methylprednisone
Avoid large volume resuscitation
~~~

Try to avoid the fluroquinolones because they are quite big guns and they also partially treat TB

Question 2

DOCUMENTATION

Answer 2

HISTORY

Clinical Features:

2 or more ssx:

fever/childs/cough/sputum, new cough, dyspnea, sweats/wt loss

+ ausc findings < AE

+ opacity on CXR

Travel
Animal Exposure
Residence in TB endemic country
Recent health-care contact (admission, IV antibiotics)
Review prior culture results (drug-resistant organisms?)

RISK FACTORS

Elderly

PMHx: Asthma, COPD; CHF, CRF, Liver Failure; DM, HIV;

Meds: Steroid use, recent (<3 month) antibiotic use

Tobacco Smoking, Alcoholism

Hospitalization in < 3 mo

Question 3

4 considerations when prescribing an antibiotic for pneumonia

Answer 3

1. Allergies
2. Interactions
   ie are they on warfarin
   Are they old and on an ACE (THen avoid Septra)
3. Aspiration coverage necessary or not (Would give amox clav or clinda)
4. COPD?