Fitzgerald Flashcards
Iron effects on “floxacin” abx
When taken with metals such as iron, calcium, potentially dairy products, magnesium, and aluminum there’s a 60 to 70% reduction in dose must separate from metals by greater than two hours.
Tetracycline, including doxycycline and minocycline should also be separated from irons by greater than two hours, true or false
True
No significant
comorbidities
including COPD,
diabetes, renal
or heart failure,
asplenia,
alcoholism
Likely causative pathogens of community acquired PNA:
S. pneumoniae (Gram-positive)
M. pneumoniae (Atypical pathogen)
C. pneumoniae (Atypical pathogen)
Respiratory viruses, including
influenza A/B,
RSV
With
comorbidities
including chronic
heart, lung,
liver, or renal
disease, DM,
alcoholism,
current
malignancy
and/or asplenia
S. pneumoniae (Gram-positive)
H. influenzae (Gram-negative)
M. pneumoniae (Atypical pathogen)
C. pneumoniae (Atypical pathogen)
Legionella spp. (Atypical pathogen)
Respiratory viruses as above
true or false
“As bacterial pathogens often coexist
with viruses and there is no current
diagnostic test accurate enough or fast
enough to determine that CAP is due
solely to a virus at the time of
presentation, our recommendations are
to initially treat empirically for possible
bacterial infection or coinfection.
What diseases are caused by s. pneumonia
COMPS
C. onjuctivitis
O.titis Media
M.eningitis
P.neumonia
S.inusitis
Strep Pneumoniae
Is gram negative or positive
gram postive diplococci
H. influenzae Is gram negative or positive
Gram negative bacillus
≥30% penicillin-resistant via
production of beta-lactamase that
cleaves beta-lactam ring in most
penicillins including amoxicillin,
ampicillin. Most cephalosporins are
stable in presence of beta-lactamase
C. pneumoniae
M. pneumoniae
Not revealed by gram stain
Staph Aureus
Is gram negative or positive
gram positive cocci
Most likely pathogens in COPD PNA
S.pneumoniae
Moraxella Catarrhalis (gram -)
Haemophilus influenza
Most likely pathogen in Post CVA-aspiration
– Oral flora, Streptococcus pneumoniae
Rusty sputum is most likely what pathogen in PNA
Streptococcus (S.) pneumoniae
a typical pathogen responsible for community-acquired pneumonia (CAP). This pathogen is often associated with sudden-onset pneumonia, productive cough, pleuritic chest pain, and consolidation on chest x-ray
Minimum Diagnostic Evaluation in CAP
CBC with WBC Differential, BUN/Cr,
Chest X-ray
Imaging in CAP Diagnosis
Chest X-ray
– Lobar consolidations
– Interstitial infiltrates
– Radiographic
appearance alone
can not reliably
differentiate among
pneumonia etiologies.
CAP treatment options
Levofloxacin or
-Doxycycline, azithromycin or clarithromycin
(macrolide) PO plus beta-lactam, such as amoxicillinclavulanate (up to amox 4 g/d), cefpodoxime
(Vantin®), cefuroxime (Ceftin®), all given PO
Avoid use with ACEI or ARB due to hyperkalemia risk:
TMP-SMX is associated with an increased risk of hyperkalemia, especially when used with ACE inhibitors (ACEI) or angiotensin receptor blockers (ARB).
Vulnerable to destruction by beta-lactamase:
Amoxicillin is a beta-lactam antibiotic and can be destroyed by bacterial beta-lactamase enzymes, which makes it less effective against beta-lactamase-producing organisms.
Use associated with tendon rupture risk, especially when used with systemic corticosteroids:
Moxifloxacin is a fluoroquinolone, and fluoroquinolones are known to increase the risk of tendon rupture, particularly when used in combination with corticosteroids.
Less than 1% cross-risk in PCN allergy
Cefpodoxime is a third-generation cephalosporin, and cephalosporins generally have a low cross-reactivity with penicillin (less than 1% in most cases).
Mycoplasma pneumoniae
This pathogen is known for causing a prolonged illness, often with a dry cough, headache, and mild systemic symptoms without severe fever or dyspnea. It is a common cause of “walking pneumonia” in otherwise healthy adults
best treatment for Mycoplasma pneumoniae?
A 7-day course of oral doxycycline.
Doxycycline is an appropriate first-line antibiotic for atypical pneumonia caused by Mycoplasma pneumoniae.
