Pneumonia Flashcards
Pneumonia
Infiltrates of the lower respiratory tract as micro organisms gain access by aspiration, inhalation, or hematogenous dissemination
Most common microorganism in  CAP
Strep pneumoniae
Signs and symptoms of pneumonia
Fever Shaking chills Purulent sputum Lung consolidation on physical exam Malaise Increased fremitus
Lab and Diagnostics for pneumonia
Elevated WBC‘s
Infiltrates by chest x-ray
Consider a sputing gram stain and culture if indicated
Chest x-ray and consider three blood cultures
ABG if respiratory failure suspected
CURB 65 Criteria
Confusion with abbreviated mental test score less than eight BUN > 19 RR > 30 SBP < 90 or DBP < 60 Age > 65
Low risk 0–1: consider home treatment
Moderate risk 2 : consider brief hospital admission with supervised treatment
High risk > three: hospital mission for severe pneumonia; consider anticipate unit
outpatient CAP management
Low Risk
Low severity: amoxicillin 1 g TID or doxycycline 100 mg b.i.d. or macrolide if less than 25% resistance (azithromycin or clarithromycin if > 25%)
Outpatient CAP management
Moderate to high severity
MRSA
Augmentin or cephalosporin
Cefpodoxime/cefuroxime + macrolide or doxycycline OR
Mono therapy with respiratory fluoroquinolone
Outpatient CAP management
Viral < 48 hours
Oseltamivir or zanamivir
Inpatient CAP management
Non severe
S.pneumoniae, H. Influenzae, M. Pneuminiae, C. Pneumoniae, legionella
Beta lactam + macrolide OR
Mini therapy with respiratory fluoroquinolone
Inpatient CAP management
Severe
S.pneumoniae, S. Aureus, legionella, gram neg bacilii, H.influenzae
Beta lactam + IV fluoroquinolone or IV azithromycin
Inpatient CAP management
Pseudomonas
Zosyn or meropenem or cefepime
Plus
AMinoglycosides/azithromycin
Inpatient CAP management
MRSA
PLUS Vanco or Linezolid
Inpatient CAP management
Viral
Oseltamivir
Peramivir
Zanamivir
+- ABX for secondary infection
B-lactam
Ceftriaxone , cefotaxime, Ceftaroline, unasyn ( ampicillin-sulbactam)
Zosyn, cefepime, meropenem
Aztreonam
Fluoroquinolone
Levofloxacin or moxifloxacin
HAP
Pneumonia that occurs 48 hours or more after admission, which was not incubated at the time of admission.
Staphylococcus aureus, streptococcus pneumoniae, and H influenzae are the most common closet of organisms
Empiric therapy for HAP
With no factors increasing likelihood of MRSA, not at high risk for mortality
Zosyn
Cefepime
Levofloxacin
Meropenem
Empiric therapy for HAP
With factors increasing the likelihood of MRSA, Not at high risk for mortality
Zosyn Cefepime or ceftazidime Levofloxacin or ciprofloxacin Meropenem aztreonam
PLUS Vanco or Linezolid
Empiric therapy for HAP
High risk of mortality or IV antibiotic within previous 90 days
TWO ( avoid 2 beta-lactam )
Zosyn Cefepime or ceftazidime Levofloxacin or ciprofloxacin Meropenem Amikacin or gentamycin or tobramycin Aztreonam
PLuS Vanco or Linezolid
VAP
Pneumonia that arises more than 48–72 hours after endotracheal intubation
Pseudomonas is the most causative organism
VAP management
ABX with MRSA activity
Vanco or Linezolid
VAP Management
Gram neg ABX with antipseudomonal activity
Beta-lactam based
Zosyn or
Cefepime, Ceftazidime or
Imipenem, meropenem or
Aztreonam
VAP Management
Gram neg ABX with antipseudomonal activity
Non beta-lactam based
Levofloxacin
Ciprofloxacin
Macrolide
Azithromycin
Fluoroquinolone
Levofloxacin
AMinoglycosides
Tobramycin
Gentamycin
