Infectious Diseases II: Lower Respiratory Tract Infections Flashcards
Acute Bronchitis is primarily caused by what type of pathogen?
Viral pathogens (90%)
Bacteria that can cause bronchitis
M. pneumoniae
H. influenzae
B. pertussis
C. pneumoniae
What is acute bacterial exacerbation of chronic bronchitis?
COPD exacerbation
Incr in sputum purulence, sputum volume, dyspnea, or mechanical ventilation require antibiotic treatment
Supportive care for bronchitis
usually viral infection
fluids
antipyretics
antitussive agents
Antibiotics used for bronchitis
Azithromycin (Zpak)
Clarithromycin 500 mg BID x 7
Bactrim DS BID x 14
Antibiotics for COPD exacerbations
Amox/clav
Azithromycin
Doxycycline
5-10 days
Most common pathogens of CAP
S. pneumoniae
H. influenzae
Mycoplasma pneumoniae
THis is the gold standard for diagnosis of CAP
chest x-ray
presents of infiltrates
Why is cipro not considered a “respiratory FQ”?
Insufficient coverage against s. pneumoniae
Factors [2] that determine antibiotic choice for outpatient CAP treatment
Presence of comorbidities
Recent use of antibiotics (w/in the past 3 mons)
What common pathogen of CAP are we worried about in regards to drug resistance?
S. pneumoniae
1st line antibiotics for pts with no recent antibiotic use and previosuly healthy: [2]
Macrolide
OR
Doxycycline
1st line antibiotics for pts with previous antibiotic use and/or chronic conditions/immunosupression (heart, liver, lung disease, diabetes, etc): [2]
- Beta lactam + macrolide or doxycycline
B-lactam: high-dose amoxicillin, Augmentin, cefdinir, cefuroxime
OR - Moxifloxacin, levofloxacin, gemifloxacin
What should not be used for CAP if the pt requires hospitalization?
Macrolide/doxycycline monotherapy
Only use:
Beta-lactam + marcolide/doxycycline
FQ montherapy
Duration of therapy for CAP
5-7 days
all depends on pt’s response
Definition of hospital acquired pneumonia (HAP)
pneumonia that occurs in non-ventilated pts who have been hospitalized for 48 hrs or greater
Definition of ventilator associated pneumonia (VAP)
penumonia that occurs in pts that have been on a vent for 48 hrs or greater
Risk factors for MRSA, and other MDR pathogens
IV antibiotics within 90 days
High prevalence of MRSA in the unit
Positive MRSA screen
Empiric antibiotics for HAP/VAP for pts without high risk of mortality and low risk for MRSA and other MDR pathogens:
Cover pseudomonas and MSSA (choose 1): Zosyn Cefepime Levofloxacin Imipenem/cilastin or meropenem
What drug should be added if there is risk factors for MRSA?
Vanco
Linezolid
Empiric drug choices for pts with high risk of mortality and high risk of MDR pathogens (antibiotics w/in 90 days):
Double coverage for pseudomonas (avoid 2 beta lactams):
Zosyn, cefepime, ceftazidime, imipenem/cilastatin, merrem
Levofloxacin, ciprofloxacin
Aminoglycosides
Duration of treatment for HAP/VAP
7 days
longer duration may be needed
