Community Acquired Pneumonia

Question 1

Definition of CAP

Answer 1

Pneumonia infection occurred outside of the hospital or within 48 hours of hospital admission.
Patients who are residents of long term care facilities are not included here

Question 2

Most common etiology is bacterial Outpatient and Inpatient Non-ICU

Answer 2

S. pneumonia

Mycoplasma pneumoniae

Question 3

Most common etiology is bacteria Inpatient ICU

Answer 3

S. pneumoniae

Staphyloccous aureus

Question 4

Etiology of Typical and Atypical

Answer 4

Typical: Streptococcus pneumonia

Atypical:
**Mycoplasma pneumoniae
Chlamydia pneumonia
Legonella
Respiratory viruses (Influenza)

Question 5

Factors that may suggest Legionella

Answer 5

Recent travel: Within 2 weeks, Hotel stays or cruise ships
High fever (> 104F)
Male
Multilobar involvement
GI symptoms
Neurologic involvement
Diffuse parenchymal involvement on xray

Question 6

Tips to determine etiology

Answer 6

Streptococcus pneumoniae
Most common
May have rust colored sputum

Mycoplasma pneumonia (walking pneumonia)
< 50 years of age without significant comorbidities; normal vital signs

Question 7

CURB-65

Answer 7

C	Confusion
U	BUN > 19 mg/dl
R	RR > 30 bpm
B	BP < 90/60
Age ≥ 65

1 point for each “yes” Hospitalize if > 1

Question 8

Empiric antibiotic treatment: Not hospitalized No-Comorbidities

Answer 8

**Azithromycin
Clarithromycin
**Doxycycline

Question 9

Empiric antibiotic treatment: Not hospitalized + Comorbidities

Answer 9

**Respiratory FQ

Azithromycin or Clarithromycin + high dose Amox or high dose Amox-CL, cefdinir, cefpodoxime, cefprozil

Question 10

Empiric antibiotic treatment: Hospitalized Not in the ICU

Answer 10

Ceftriaxone (Rocephin) + Azithromycin
OR Ertapenem + Azithromycin
OR Levo or Moxi

Question 11

Empiric antibiotic treatment: Hospitalized in the ICU

Answer 11

Levo or Moxi + Azithro

OR Ceftriaxone + Azithro

Question 12

Prevention

Answer 12

Pneumococcal vaccine (against 23 strains of S pneumonia)
Seasonal influenza vaccine