Infectious Diseases II: Lower Respiratory Tract Infections

Question 1

Acute Bronchitis is primarily caused by what type of pathogen?

Answer 1

Viral pathogens (90%)

Question 2

Bacteria that can cause bronchitis

Answer 2

M. pneumoniae
H. influenzae
B. pertussis
C. pneumoniae

Question 3

What is acute bacterial exacerbation of chronic bronchitis?

Answer 3

COPD exacerbation

Incr in sputum purulence, sputum volume, dyspnea, or mechanical ventilation require antibiotic treatment

Question 4

Supportive care for bronchitis

Answer 4

usually viral infection

fluids
antipyretics
antitussive agents

Question 5

Antibiotics used for bronchitis

Answer 5

Azithromycin (Zpak)
Clarithromycin 500 mg BID x 7
Bactrim DS BID x 14

Question 6

Antibiotics for COPD exacerbations

Answer 6

Amox/clav
Azithromycin
Doxycycline

5-10 days

Question 7

Most common pathogens of CAP

Answer 7

S. pneumoniae
H. influenzae
Mycoplasma pneumoniae

Question 8

THis is the gold standard for diagnosis of CAP

Answer 8

chest x-ray

presents of infiltrates

Question 9

Why is cipro not considered a “respiratory FQ”?

Answer 9

Insufficient coverage against s. pneumoniae

Question 10

Factors [2] that determine antibiotic choice for outpatient CAP treatment

Answer 10

Presence of comorbidities

Recent use of antibiotics (w/in the past 3 mons)

Question 11

What common pathogen of CAP are we worried about in regards to drug resistance?

Answer 11

S. pneumoniae

Question 12

1st line antibiotics for pts with no recent antibiotic use and previosuly healthy: [2]

Answer 12

Macrolide
OR
Doxycycline

Question 13

1st line antibiotics for pts with previous antibiotic use and/or chronic conditions/immunosupression (heart, liver, lung disease, diabetes, etc): [2]

Answer 13

1. Beta lactam + macrolide or doxycycline
   B-lactam: high-dose amoxicillin, Augmentin, cefdinir, cefuroxime
   OR
2. Moxifloxacin, levofloxacin, gemifloxacin

Question 14

What should not be used for CAP if the pt requires hospitalization?

Answer 14

Macrolide/doxycycline monotherapy
Only use:
Beta-lactam + marcolide/doxycycline
FQ montherapy

Question 15

Duration of therapy for CAP

Answer 15

5-7 days

all depends on pt’s response

Question 16

Definition of hospital acquired pneumonia (HAP)

Answer 16

pneumonia that occurs in non-ventilated pts who have been hospitalized for 48 hrs or greater

Question 17

Definition of ventilator associated pneumonia (VAP)

Answer 17

penumonia that occurs in pts that have been on a vent for 48 hrs or greater

Question 18

Risk factors for MRSA, and other MDR pathogens

Answer 18

IV antibiotics within 90 days
High prevalence of MRSA in the unit
Positive MRSA screen

Question 19

Empiric antibiotics for HAP/VAP for pts without high risk of mortality and low risk for MRSA and other MDR pathogens:

Answer 19

Cover pseudomonas and MSSA (choose 1):
Zosyn
Cefepime
Levofloxacin
Imipenem/cilastin or meropenem

Question 20

What drug should be added if there is risk factors for MRSA?

Answer 20

Vanco

Linezolid

Question 21

Empiric drug choices for pts with high risk of mortality and high risk of MDR pathogens (antibiotics w/in 90 days):

Answer 21

Double coverage for pseudomonas (avoid 2 beta lactams):
Zosyn, cefepime, ceftazidime, imipenem/cilastatin, merrem
Levofloxacin, ciprofloxacin
Aminoglycosides

Question 22

Duration of treatment for HAP/VAP

Answer 22

7 days

longer duration may be needed