Pneumonia

Question 1

Duration of therapy for pneumonia in adults

Answer 1

Treat for a minimum of 5 days and until afebrile for 48-72hrs
Azithromycin 3 vs 5 days does not appear to have a difference but limited evidence

Question 2

Most common pathogens in CAP for Peds

Answer 2

Infants: viruses
3 mo - 5 yrs: S. pneumoniae and viruses
>5 yrs: M. pneumoniae, C. pneumoniae

H. influenza rare due to vaccination

Question 3

First line for uncomplicated CAP for peds

Answer 3

Amoxicillin
Pen allergy (rash): cefuroxime, cefprozil
Pen allergy (anaphylaxis): Doxycycline (>8yrs), azithromycin, clarithromycin

• uncomplicated means acute, CAP in healthy immunized children without underlying pulmonary pathology

Question 4

Duration of therapy for Peds

Answer 4

7-10 days (except azith)

Question 5

Higher doses of _____ cover majority of PRSP

Answer 5

Amoxicillin (75-90mg/kg/d)

*consider if daycare, ABX within prev 3 months, failure of initial treatment

Question 6

First line for adult CAP

Answer 6

Doxycycline
Has S. pneumoniae, H influenzae, S aureus, and atypical coverage
Has high serum and lung drug concentations, and concentration dependent killing

Question 7

CAP Risk Severity Tools

Answer 7

PSI>CURB-65
Also SMART-COP, SCAP, IDSA/ATS (for hospital)
SOAR (LTC)

Question 8

Outpatient, no modifying factors pathogens and treatment

Answer 8

Pathogens: S pneumoniae, mycoplasma pneumoniae, chlamydophilia pneumoniae, viral
Treatment: Doxy, or Amoxi +/- macrolide

Question 9

Outpatient, comorbidity Pathogens and treatment

Answer 9

P: Same as no modifying factors (s, pnuemonaie, m pneumoniae, c pneumonaie) + h influenzae, m catarrhalis, s aureus, legionella
T: doxy or amoxi/clav +/- macrolide (SK)

Question 10

Gram negative rod more likely if

Answer 10

nursing home, CV/lung dx, recent ABX use/steroid use

Question 11

Pathogens and treatment for general ward admission

Answer 11

P: S/M/C pneumonaie, H influenzae, legionella, gram -ve
T: 2nd, 3rd, or 4th gen ceph, or amoxi or amoxi/clav + macrolide or doxy
or FQ alone

Question 12

ICU pathogens and treatment

Answer 12

P: S/M/C pneumoniae, h influenzae, legionella, gram -ve, enteric gram - rods (klebsiella, enterobacter), s aureus
T: 3rd gen ceph IV + macrolide or 3rd gen ceph + FQ

If beta lactam allergy: FQ + clindamycin

Question 13

Resp FQ

Answer 13

Levo or Moxi, not ciprofloxacin unless pseudomonas suspected

Question 14

ICU risk of pseudomonas treatment

Answer 14

All the same other pathogens, plus pseudomonas
Treatment: Anti P FQ (cipro, levo) + AntiP B lactam (imipenem, meropenem, ceftazadime, cefepime)
2nd line: triple IV therapy (antiP b lactam + macrolide (or FQ) + AMG)

Question 15

Aspiration pneumonia pathogens and treatment

Answer 15

P: oral anaerobes
T: Amoxi/clav
2nd: ceftriaxone, or levofloxacin + metronidazole

Question 16

What is recommended to confirm pneumonia?

Answer 16

A chest x ray

Question 17

Which bacteria is the most common?

Answer 17

S pneumonaie, even in those with comorbidities

Question 18

Are sputum cultures recommended?

Answer 18

No, hard to get a valid one

Question 19

CRB-65 risk rating scale pearls

Answer 19

Quick, easy, does not require blood work, can assess general mortality risk
Does not account for comorbidities tho so PSI preferred if possible

Question 20

Treatment regimens of choice for previously healthy adults with no recent ABX use

Answer 20

Doxy for 5-7 days

Or Amoxicillin +/- macrolide if worried about atypicals

Question 21

Treatment of choice for adult outpatient with comorbidities

Answer 21

Doxy 5-7 days

Or amoxi/clav +/- macrolide for atypicals

Question 22

Risk factor for ABX resistant S pneumoniae

Answer 22

age >65, cardiac, pulmonary, renal or hepatic failure, smoking, alcoholism, malignancy, DM, malnutrition, immunosuppression