Lower Respiratory Infections

Question 1

When is Palvizumab indicated?

Answer 1

prophylaxis for respiratory synctial virus (*mc acute bronchiolitis) in underlying heart or lung disease infant

Question 2

What are the 3 hallmarks of chronic bronchitis?

Answer 2

1. Chronic cough
2. Excessive sputum
3. Purulent sputum

Question 3

Tx for simple chronic bronchitis, no or few risk factors?

Answer 3

Macrolide (or Doxycyline, amoxicillin, TMP/SMX)

Question 4

Tx for complicated bronchitis with severe symptoms

Answer 4

Fluroquinolone (or Augmentin)

Question 5

Tx for outpatient, community acquired pneumonia with no antibiotics in the past 3 months?

Answer 5

Macrolide (or Doxycycline)

Question 6

Tx for outpatient, community acquired pneumonia with antibiotics in the past 3 months, or high risk patient?

Answer 6

Fluroquinolone (moxifloxacin, gemifloxacin)

or

Macrolide + beta lactam (amoxicillin)

Question 7

Tx for inpatient community acquired pneumonia?

Answer 7

Fluroquinolone (moxifloxacin or levofloxacin)

or

Macrolide + beta lactam (IV - ampicillin, ceftaxime, ceftriaxone)

Question 8

Tx for community acquired ICU pneumonia?

Answer 8

Fluroquinolone + antipneumococcal beta lactam (cefotaxime, ceftriaxone, or ampicillin- sulbactam)

or

Fluroquinolone + azotreonam (if beta lactam allergy)

Question 9

Tx for community acquired Pneumonia, ICU with concern for pseudomonas?

Answer 9

Fluroquinolone + Pipercillin-tazobactam (or cefepime)

or

Fluroquinolone (or Azithromycin) + pipercillin-tazobactam + aminoglycoside

Question 10

Commuinity acquired PNA in the ICU with concern for MRSA?

Answer 10

Fluroquinolone + pipercillin-tazobactam + vancomycin (or linezolid)

Question 11

Name 3 risk factors for MDR pathogen

Answer 11

1. ABO in the past 90 days
2. 5 or more days in the hospital
3. Septic shock

Question 12

Hospital acquired pneumonia treatment

Answer 12

Piperacillin-tazobactam IV

or

Cefepime

or

Fluroquinolone (levofloxacin)

Question 13

Ventilator acquired pneumonia treatment

Answer 13

Piperacillin-tazobactam + Vancomycin

or

Cefepime + Vancomycin

or

Fluroquinolone (levofloxacin) + Vancomycin

Question 14

Hospital Acquired Pneumonia with pseudomonas risk factors

Answer 14

(pipercillin-tazobactam or cefipime or aztreonam) + (levofloxacin or aminoglycoside)