Pneumonia

Question 1

If CURB 0-1, what is first line for CAP?

Answer 1

Caused by: Strep pneumoniae/Haemophilus influenzae
Antibiotic: Oral amoxiciliin 500mg/8hrs, clarithromycin 500mg/12hrs OR doxycycline 200mg loading followed by 100mg/day (5 days)

Question 2

If CURB 2, what is first line for CAP?

Answer 2

Caused by: Strep pneumoniae/Haemophilus influenzae/Mycoplasma pneumoniae
Antibiotic: Same as 0-1 but if IV required then amoxicillin + clarithromycin in same dosage.

Question 3

If CURB>3, what is first line CAP?

Answer 3

IV Co-amoxiclav 1.2g/8hrs or IV cephalosporin 1.5g/8hrs AND IV clarithromycin 500mg/12hrs

Question 4

What antibiotics would be added if PVL-producing Staph Aureus suspected?

Answer 4

Linezolid, rifampicin and clindamycin

Question 5

What organisms cause noscomially acquired pneumonia?

Answer 5

Gram-negative bacilli, pseudomonas, anaerobes

Question 6

How are HAIs treated?

Answer 6

Aminoglycoside IV + antipseudomonal penicillin IV

Question 7

How is aspiration pneumonia treated?

Answer 7

Caused by Strep pneumoniae or anaerobes. Treated with cephalosporin IV or metronidazole IV.

Question 8

What are the 7 complications of pneumonia?

Answer 8

Respiratory failure (Type 1), Hypotension, Atrial fibrillation, Pleural effusion, Empyema, Lung abscess, Septicaemia

Question 9

How is Type 1 Resp failure treated?

Answer 9

High-flow (60%) oxygen. Transfer patient to ITU if hypoxia does not improve upon O2 therapy.

Question 10

How is hypotension treated?

Answer 10

May be due to dehydration/vasodilation caused by sepsis. If systolic BP <90mmHg, IV fluid challenge of 250ml given over 15 mins. If it still doesn’t rise, consider central line or ITU for inotropic support.

Question 11

How is atrial fibrillation treated?

Answer 11

Common in the elderly. Beta blocker or digoxin to slow ventricular response until pneumonia resolves.

Question 12

How is pleural effusion treated?

Answer 12

Drainage required if it develops into an empyema.

Question 13

How is empyema treated?

Answer 13

Refers to pus in pleural space. Suspected when a patient with resolving pneumonia develops a recurring fever. CXR shows a pleural effusion and aspirated fluid is yellow with ph<7.2, low glucose and high LDH. Empyema should be drained using chest drain.

Question 14

What are the causes of lung abscess?

Answer 14

1. Inadequately treated pneumonia
2. Aspiration (alcoholism, oesophageal obstruction, bulbar palsy)
3. Bronchial obstruction
4. Pulmonary infarction
5. Septic emboli (septicaemia, right heart endocarditis)
6. Subphrenic or hepatic abscess

Question 15

What are the clinical features of a lung abscess?

Answer 15

Swinging fever, purulent sputum, pleuritic pain, haemoptysis, malaise, weight loss. Look for: finger clubbing, anaemia, crepitations.

Question 16

How is a lung abscess treated?

Answer 16

Antibiotics - continue until healed. Postural drainage, repeated aspiration and antibiotic instillation.

Question 17

What can cause septicaemia and how is it treated?

Answer 17

May occur as a result of spread from lung parenchyma into the bloodstream. May cause metastatic infection e.g. infective endocarditis or meningitis. Treat with IV antibiotics.