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Infectious Disease > Lower Respiratory Tract Infections > Flashcards

Lower Respiratory Tract Infections Flashcards

1
Q

Community Acquired Pneumonia (CAP)

A

Onset outside of the hospital or < 48 hours from hospital admission

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2
Q

CAP Outpatient Empiric Therapy if No Comorbidities and No Antimicrobial Use Within 90 Days

A

High-dose amoxicillin (preferred)
Doxycycline
Azithromycin (if pneumococcal resistance < 25%)

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3
Q

CAP Outpatient Empiric Therapy if Comorbidities or Antimicrobial Use Within 90 Days

A

Combination Therapy:
Augmentin or 2nd Gen PO CEPH (cefpodoxime or cefuroxime) PLUS EITHER
Macrolide or Doxycycline

Monotherapy: respiratory FQ (levofloxacin or moxifloxacin)

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4
Q

CAP Inpatient, Non-ICU Empiric Therapy No PCN Allergy

A

Ampicillin/sulbactam, cefotaxime, ceftriaxone, or ceftaroline PLUS EITHER
Macrolide or doxycycline

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5
Q

CAP Inpatient, Non-ICU Empiric Therapy if PCN Allergy

A

Levofloxacin or moxifloxacin

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6
Q

CAP Inpatient, ICU Empiric Therapy No PCN Allergy

A

Ampicillin/sulbactam, cefotaxime, ceftriaxone, or ceftaroline PLUS EITHER
Macrolide or fluoroquinolone

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7
Q

CAP Inpatient, ICU Empiric Therapy if PCN Allergy

A

Aztreonam PLUS

Levofloxacin or moxifloxacin

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8
Q

Risk Factors for MRSA

A 
Antibiotic use within 90 days
ESRD
Prior influenza infection
Radiographic finding of cavitary/necrotizing lesions
Structural lung disease
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9
Q

CAP MRSA Therapy

A

Add vancomycin or linezolid to regimen

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10
Q

Risk Factors for Pseudomonas

A

Antibiotic use within 90 days
Alcoholism
COPD
Structural Lung Disease

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11
Q

CAP Pseudomonas Therapy

A

Anti-pneumococcal, anti-pseudomonal beta-lactam (Zosyn, Cefepime, Meropenem) PLUS EITHER
Fluoroquinolone or Aminoglycoside PLUS
Azithromycin

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12
Q

CAP Directed Therapy - S. pneumoniae (PCN-susceptible)

A

Amoxicillin or PCN G

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13
Q

CAP Directed Therapy - S. pneumoniae (PCN-resistant)

A

Cefotaxime, ceftriaxone, levofloxacin, moxifloxacin

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14
Q

CAP Directed Therapy - H. influenzae (non-beta-lactamase)

A

Amoxicillin

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15
Q

CAP Directed Therapy - H. influenzae (beta-lactamase)

A

Cefotaxime or ceftriaxone

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16
Q

CAP Directed Therapy - MSSA

A

Dicloxacillin, Oxacillin, Nafcillin

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17
Q

CAP Directed Therapy - MRSA

A

Vanco or linezolid

18
Q

CAP Directed Therapy - Legionella

A

Fluoroquinolone or macrolide

19
Q

CAP Duration of Therapy

A

5 days

20
Q

Hospital-Acquired Pneumonia (HAP)

A

Occurring at least 48 hours from admission, with no prior sxs

21
Q

HAP High Mortality Risk

A

Need for ventilator support due to pneumonia

Septic shock

22
Q

HAP MRSA Coverage Needed

A

IV antibiotic use within 90 days

Unit where prevalence of MRSA > 20%

23
Q

HAP Double Pseudomonas Coverage Needed

A

IV antibiotic use within 90 days

Structural lung disease

24
Q

HAP Empiric Therapy if Low Risk for Mortality and MDR GNR and Local MRSA < 20%

A

Beta-lactam (Zosyn, Cefepime, Meropenem, Imipenem) OR

Levofloxacin

25
Q

HAP Empiric Therapy if Low Risk for Mortality and MDR GNR and Local MRSA > 20%

A

Beta-lactam (Zosyn, Cefepime, Meropenem, Imipenem, Aztreonam) OR
Levofloxacin or ciprofloxacin PLUS
Vanco or linezolid

26
Q

HAP Empiric Therapy if High Risk for Mortality or MDR GNR

A

Double Pseudomonas coverage from 2 separate classes: beta-lactams (Zosyn, Cefepime, Meropenem, Imipenem, Aztreonam), fluoroquinolones (Ciprofloxacin, Levofloxacin), aminoglycosides (amikacin, gentamycin, tobramycin) PLUS
Vanco or linezolid

27
Q

HAP Duration of Therapy

A

7 days

28
Q

VAP MDR Risk Factors

A

IV antibiotics within 90 days
Septic shock
ARDS and renal replacement therapy prior to VAP
Hospitalization at least 5 days prior to VAP

29
Q

VAP MRSA Coverage Needed

A

MDR VAP Risk Factors

Unit where prevalence of MRSA > 10%

30
Q

VAP Double Pseudomonas Coverage Needed

A

MDR VAP Risk Factors

Units where resistance to anti-pseudomonal agent > 10%

31
Q

VAP Empiric Therapy if No MDR VAP Risk Factors and Local MRSA and GNR Resistance < 10%

A

Beta-lactam (Zosyn, Cefepime, Meropenem, Imipenem) OR

Levofloxacin

32
Q

VAP Empiric Therapy if No MDR VAP Risk Factors, Local MRSA > 10%, and GNR Resistance < 10%

A

Beta-lactam (Zosyn, Cefepime, Meropenem, Imipenem, Aztreonam) OR
Levofloxacin or ciprofloxacin PLUS
Vanco or linezolid

33
Q

VAP Empiric Therapy if No MDR VAP Risk Factors, Local MRSA < 10%, and GNR Resistance > 10%

A

Double Pseudomonas coverage from 2 separate classes: beta-lactams (Zosyn, Cefepime, Meropenem, Imipenem, Aztreonam), fluoroquinolones (Ciprofloxacin, Levofloxacin), aminoglycosides (amikacin, gentamycin, tobramycin), polymyxins (colistin or polymyxin B)
At least one agent active against S. aureus

34
Q

VAP Empiric Therapy if No MDR VAP Risk Factors and Local MRSA and GNR Resistance > 10%

A

Double Pseudomonas coverage from 2 separate classes: beta-lactams (Zosyn, Cefepime, Meropenem, Imipenem, Aztreonam), fluoroquinolones (Ciprofloxacin, Levofloxacin), aminoglycosides (amikacin, gentamycin, tobramycin), polymyxins (colistin or polymyxin B) PLUS
Vanco or linezolid

35
Q

VAP Empiric Therapy if MDR VAP Risk Factors

A

Double Pseudomonas coverage from 2 separate classes: beta-lactams (Zosyn, Cefepime, Meropenem, Imipenem, Aztreonam), fluoroquinolones (Ciprofloxacin, Levofloxacin), aminoglycosides (amikacin, gentamycin, tobramycin), polymyxins (colistin or polymyxin B) PLUS
Vanco or linezolid

36
Q

Duration of VAP Therapy

A

7 days

37
Q

HAP/VAP Directed Therapy - MRSA

A

Vancomycin or linezolid

38
Q

HAP/VAP Directed Therapy - Pseudomonas

A

Per antibiotic susceptibility results
Continue combination therapy for septic shock/high mortality risk
Monotherapy if septic shock resolves

39
Q

HAP/VAP Directed Therapy - Acinetobacter

A

Per antibiotic susceptibility results
Carbapenem
Ampicillin/sulbactam
Polymyxin + inhaled colistin

40
Q

HAP/VAP Directed Therapy - ESBL GNR

A

Carbapenem treatment of choice

41
Q

HAP/VAP Directed Therapy - CRE

A 
IV polymyxin + inhaled colistin
Ceftolozane/tazobactam
Ceftazidime/avibactam
Imipenem/relebactam
Cefidercol

Infectious Disease (15 decks)

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