Lower Respiratory Tract Infections

Question 1

what is pneumonia

Answer 1

new lung infiltrate with evidence that it is of infectious origin, whic h includes

• new onset of fever
• leukocytosis
• purulent sputum
• decrease oxygenation

often times RR>30, HR>100, fever >100

Question 2

signs/sx of pneumonia

Answer 2

Cough, sputum production, Dyspnea, fever and chills, hemoptysis, pleuritic chest pain, tachypnea, tachycardia, diminished breathe sounds, egophony, increased WBC

Question 3

CAP outpatient treatment for healthy individual who has no risk factors for resistance

Answer 3

• PO amoxicillin (DOC)
• PO doxycycline
• PO macrolide (azithro, clarithro)

Question 4

CAP outpatient treatment for patient with comorbidity

Answer 4

Amoxicillicin/clavulate OR cephalosporin PLUS macrolide (azithro/micro)

PO respiratory quinolone (levo or moxi)

Question 5

CAP inpatient treatment for non-severe and severe

Answer 5

IV beta lactam (amplicillin/sulbactram, ceftriaxone) PLUS macrolide OR respiratory quinolone (levo or moxi)

usually longer therapy for severe(sepsis)

Question 6

how long to treat CAP

Answer 6

Treat minimum of 5 days, generally 7 days

should be afebrile for 48-72 hours

Question 7

Treatment for legionella

Answer 7

IV levofloxacin x10-21 days

OR

Azithromycin

Question 8

how long to treat HAP/VAP

Answer 8

7 days

Question 9

how do you treat HAP?

Answer 9

Empiricism… antibiogram more applicable to drive empiric choices

Question 10

HAP: Streptococcus pneumoniae, H. influenzae, Methicillin-sensitive S aureus

Answer 10

• Ceftriaxone
• Levofloxacin, moxifloxacin
• Ampicillin/sulbactam
• Ertapenem

Question 11

HAP: MRSA

Answer 11

• vancomycin

- linezolid

Question 12

HAP: pseudomonas

Answer 12

Piperacillin/Tazobactam, cefepime, ceftazidime, imipenem/meropenem, aztreonam, ciprofloxacin, levofloxacin, aminoglycosides, colistin, polymyxin