Lower Resp Infections Flashcards
What is the most common cause of acute bronchitis?
mostly viral (influenza, rhinovirus, coronavirus, RSV)
Treatment of Acute Bronchitis
- antibiotic therapy NOT indicated
- unless bacterial pathogen is identified with sputum culture
- symptomatic: rest, fluids, analgesics prn (aspirin, aceto, ibup); anti-tussives
What role do OTC cold medications play in tx of acute bronchitis?
none!
-those w/ decongestants will thicken sputum and make it harder to clear the infection
What are the most common pathogens in acute bacterial exacerbation of chronic bronchitis?
- up to 50% may be culture negative
- viral 20-50% of cases
- C and M pneumoniae
Tx of Acute Exacerbation of Chronic Bronchitis
- stop smoking! (COPD)
- postural drainage to clear secretions
- if severe, consider CXR, inhaled anticholinergic bronchodilator (will dry secretions), 2 week oral prednisone burst
What role do abx play in Tx of Acute Exacerbation of Chronic Bronchitis?
- mild to moderate dz: no or maybe
severe: role debated, but some value has been shown; broad spectrum like augmentin, azithro, clarithro, FQs
Clinical Presentation of Strep pneumoniae
- rust colored sputum
- rapid fever onset
- high WBC
- CXR: lobar consolidation
Clinical Presentation of Mycoplasma pneumoniae
- slow course
- non-productive cough
- WBC normal or slightly elevated
Clinical Presentation of Legionella pneumoniae
- pleuritic chest pain
- can see hemoptysis
- increased LFTs
- hyponatremia
How is CAP treatment determined?
- out vs inpatient
- and non-ICU vs ICU
- presence of co-morbidities like COPD, DM, HF
CAP Tx in Previously Healthy Outpatient with No Abx
-macrolide or doxycycline
CAP Tx in Outpatient w/ Presence of Co-morbidities, Immunosuppressing Conditions, or Use of Antimicrobials w/in 3 Months
- respiratory FQ
- or macrolide plus beta-lactam
CAP Tx in Outpatient in a region with >25% high level Macrolide Resistant Strep pneumoniae
- respiratory FQ
- or macrolide plus beta-lactam
(same as for tx of pts w/ co-morbidities)
CAP Tx of Inpatient Non-ICU
- respiratory FQ
- or macrolide plus beta-lactam
CAP Tx of Inpatient ICU with no Pseudomonas
- beta lactam and azithromycin
- or respiratory FQ
CAP Tx of Inpatient ICU with Pseudomonas
- beta lactam + cipro
- BL + azithro + AG
- BL + AG + antipneumococcal FQ
CAP Tx of Inpatient ICU with CA-MRSA
-add vancomycin or linezolid to cover MRSA
When do you switch from IV to oral CAP therapy?
- pt is hemodynamically stable
- pt improving clinically (cough, dyspnea)
- pt able to ingest meds
- normal functioning GI tract
Duration of CAP Therapy
- minimum 5 days
- afebrile 48-72 hours
- no more than 1 CAP associated sign of instability (fever, tachcayrdic, tachpneic, low SBP, low O2 sat) before discontinuation of therapy
HAP Mortality Rates
-30-50%
What pathogens cause HAP?
- P. aeruginosa
- E. coli
- Klebsiella pneumoniae
- Acinetobacter species
- Staph aureus, esp MRSA
Indication for Tamiflu/Oseltamivir
- tx of influenza A and B in adults and kids older than 2 weeks
- sxs no more than 2 days
- prophylaxis against influenza A or B in pts over 1 y.o
Tamiflu/Oseltamivir Efficacy
- reduced sxs duration by about 1 day
- begin tx w/in 24 hours
- w/in 12 hours of fever onset, decrease total illness by 3 days
Tamiflu/Oseltamivir AEs
- with tx: N/V, insomnia, vertigo
- with Px: HA, fatigue, cough, diarrhea
