Pneumonia Flashcards
CAP
Empiric antibiotics, cover :S. Pneumoniae, H. Influenzae
M. Catarrhalis, MSSA in smokers or elderly
Enterobacteriae in COPD
Atypicals: MCL
Beata Lactams are the mainstay
CAP Treatment
Healthy, under 65, no recent antibiotics: Amoxicillin for S/H and maybe (most of time) azithromycin or doxy to target atypicals
Comorbidities, 65 and older, recent antibiotics, smokers: Augmentin and azithromycin or doxy.
3rd gen cephalosporin (Cefdinir) for penicillin allergies with azithromycin or doxy
Last line is Levofloxacin monotherapy
Typically 5 days
Exceptions: Fever, high dose azithromycin, severe illness that requires hospitalization (pseudomonas, klebsiella, MRSA)
Amoxicillin
LRIs and many others
ADR: allergic rxn (penicillin allergy), C DIff and AAD
Renal adjustment requried
Augmentin
Amoxicillin/Clavulanic Acid
LRIs and more
ADR: More AAD than amoxicillin
Renal adjustment needed
Azithromycin
CAP, and more. Covers G+/-, No MRSA or Pseudomonas
Contra: Hx of jaundice/hepatic dysfunction a/w prior azithromycin use
ADR: QT prolongation
500 day then 250
Doxycycline
CAP and more
Contra: Relative for kids under 8. Teeth discoloration
ADR: GI, AAD, photosensitivity
Levofloxacin
Pneumonia and others
Covers Pseudomonas (no MRSA), very broad spectrum, not great. 3rd line agent
BOX: Tendinitis, myasthenia gravis exacerbations
Absorption decreased by Cations
HAP
48 hours after being admitted
VAP: 48 hours after ventilation
Pts have increased chance of resistant organisms and hospital mortality
Changes empiric antibiotics (more focus on entire spectrum)
Cefepime
4th Gen Cephalosporin
Pneumonia (includes pseudomonal coverage)
ADR: C DIff, AAD, Neurotoxicity
Renal adjustment needed
Vancomycin
VANCO
IV FOR SYSTEMIC INFECTIONS
ONLY USE ORAL FOR C DIFF
Pneumonia (with MRSA coverage)
ADR: Nephrotoxic, Red Man Syndrome, Thrombocytopenia
Dosed by nomogram, kidney and weight based
Zosyn
Pneumonia and others
Pipercillin/Tazobactam
ADR: Acute kidney injury particularly in combination with vanco
Renal adjustments needed
HCAP
Dialysis, nursing home residents, previous hospitalization, immunocompromised state
Has gone away mostly
Follow CAP guidelines but remember that they may need a slightly broader spectrum
Aspiration Pneumonia
Aspiration of gastric or oropharyngeal fluids with bacteria
Leads to pneumonia that is aerobic, anaerobic, or both
Same empiric treatment as CAP. Outpt: Augmentin. InPt, not severely ill: Unasyn. Inpt, severe: Zosyn
All 3 have ANAEROBIC coverage in addition to normal suspected pathogens
In a mixed etiology, may need to cover broader spectrum empirically and narrow
Unsure if Aspiration or HCAP, use ZOSYN
