Drugs for Tx of Respiratory Infections, J Kinder, DSA Flashcards
what are the common outpatient respiratory microbes causing CAP
S pneumoniae Mycoplasma pneumoniae Haemophilus influenzae Chlamydophila pneumoniae Respiratory viruses
What are the common hospitalized respiratory microbes causing CAP
S pneumoniae M pneumoniae C pnuemoniae H influenzae Legionella spp Aspiration Respiratory viruss
What are the common intensive care unit respiratory microbes causing CAP
S penumoniae S aureus Legionella Gram - bacilli H influenzae
with use of chronic oral steroids what microbes are more common with CAP
enterobacteriaceae
Pseudomonas
what are common viruses causing CAP
influenza, RSV, adeno, parainfluenza
What are risk factors for drug resistant streptococcus penumoniae
B lactam withing previous 3 mo!! age 65 yrs alcoholism immunosuppressive illness or therapy exposure to child at day care
what is empiric Tx CAP for outpatient prevoiusly healthy individual
Macrolide(zpak) or doxy
both PO
empiric Tx CAP for outpatient at risk for DRSP,
respiratory FQ PO(levo or moxi)
or
B lactam PO (amoxicillin) + macrolide PO
empiric Tx CAP for inpatient, non-ICU
Respiratory FQ PO
or
B lactam IV (ceftriazone, cefotaxime or ampicillin) + macrolide IV
empiric Tx CAP inpatient ICU
B lactam IV + azithromycin IV
or
B lactam IV + respiratory FQ
Risk factors for pseudomonas aeruginosa infection
structural lung disease
repeated COPD exacerbations
Prior antibiotic Tx
Tx for pseudomonas
Anti-pseudomonal B lactam IV (piperacillin-tazobactam, cefepime, imipenem, meropenem) \+ cipro or levo or B lactam + AG + zpak or B lactam + AG + antipseudomonal FQ
What are risk factors for community-acquired methicillin-resistant Staph aureus
end stage renal disease
injection drug abuse
prior influenza
prior antibiotic use (especially FQ)
Tx community acquired MRSA
vanco IV or linezolid
Panton-Valentine leucocidin necrotizing pneumonia (add clinda or use linezolid)
How long do you Tx CAP
minimum 5 days (most 7-10)
afebrile 48-72 hours
exception: Pseudomonas- 8 day course led to more relapse compared to 15 day course
What are common infecting organisms for HAP
Aerobic gram - : pseudomonas, E coli, Klebseilla, acinetobacter spp
gram + cocci: MRSA
oropharyngeal: viridans, coagulase - staph, neisseria, corynebacterium
What are the R mechanisms of pseudomonas
Multiple efflux pumps
decreased expression of outer membrane porin channel
chromosomal induction of B lactamases
Pseudomonas is gaining R to what
piperacillin, ceftazidime, cefepime, imipenem, meropenem, aminoglycosides, FQs
how is MRSA gaining resistance
reduced affinity of penicillin-binding proteins for B lactams
early onset HAP pathogens
S pneumoniase
H influenzae
MSSA
sensitive gram - : E coli, klebsiella, enterobacter spp, proteus spp, serratia
Tx for HAP early onset
Ceftiazone or FQ or ampicillin/sulbactam or ertapenem
what are the late onset HAP pathogens
Pseudomonas, klebsiella ESBL+, acinetobacter, MRSA
Tx for late onset HAP
antipseudomonal cephalosporin or antipseudomonal carbapenem or B lactam \++++++ antipseudomonal FQ or AG \++++++ Linezolid or vanco
Duration therapy for HAP
ventilator acquired- 6 days
usually short around 7 days
pseudomonas needs minimum 8
What are the neuroamidase inhibitors that we use for CAP
oseltamivir PO
how does oseltamivir work
analog of sialic acid, interferes with release of progeny influenza virus from infected cell
adverse effects oseltamivir
nausea, vomiting, abdominal pain, HA, fever, diarrhea, neuropsych
approved in children >1 yr
therapeutic use oseltamivir
influenza prophylaxis, influenza Tx
What are the M2 channel blockers
amantadine, rimantadine
only effective against influenza A
** not in red
What are the antivirals for HSV and VZV
acyclovir and valavyclovir
Adverse effects of acyclovir and valavyclovir
nasuea, diarrhea, HA
therapeutic use of acyclovir
genital herpes, varicella, HSV encephalitis, neonatal HSV Tx
What are the antivirals for CMV
ganciclovir and valganciclovir
What are the antifungals used to Tx CAP
fluconazole PO IV
itraconazole PO
voriconazole PO IV
MOA antifungals Tx of CAP
inhibit fungal cytochrome p450, reducing production ergosterol
adverse effects antifungals
minor GI upset, abnormal liver enzymes
what is therapeutic use of antifungals
wide spectrum of activity against Candida spp, blastomycosis, coccidiodomycosis, histoplasmosis and even aspergillus
