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Infectious Disease Therapeutics > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

Risk Factors

A

Alcohol abuse
Immunosuppression
Lung disease
Institutionalization
Age > 70

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2
Q

CAP Organisms

A
  • Strep Pneumonaie –> Most common
  • Haemophilus Influenzae
  • Staph Aereus
  • Mycoplasma Pneumonaie –> Young helathy
  • Chlamydia Pneumonaie
  • Legionella –> Uncommon
  • Viral
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3
Q

Penumonaie Atypicals

A
  • Mycoplasma Pneumaie
  • Both lobes of Lung
  • Chlamydia Pneumonaie
  • Legionella
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4
Q

Hospital Acquired Organisms

A

GRAM NEG Organism

Klebsiella pneumoniae
E coli
Enterobacter species
Proteus species
Pseudomonas aeruginosa
Staph aureus
Anaerobes
Strep pneumoniae

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5
Q

What conditions for recurring pneumona?

A

COPD and HF

Others –> Cystic Fibrosis, recent antibitocs (last 3 months)

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6
Q

Pneumonaie Symptoms (Abrupt)

A

Fever (may be high [>39°C] or low grade
Chills
Dyspnea
Cough(productive or non-productive)
Rust colored sputum or hemoptysis
Pleuritic chest pain (described as stabbing)
Other nonspecific sx

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7
Q

Physical Exam Symptoms

A

Tachypnea
Tachycardia
Dullness to percussion (palpate the lungs)  lugs should be filled with air, so should sound hollow  dullness if fluid/mucus there
Diminished breath sounds over affected area
Inspiratory crackles

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8
Q

Clinical Presentation

A
  • Chest X-ray
  • Low O2 stauration
  • Elvated WBC
  • Sputum Sample
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9
Q

Diagnosis of Pneumona

A

Physical exam
Signs and symptoms
Chest x-ray

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10
Q

Diagnosis Challenges

A
  • Viral or BActerial
  • Which microorganisms
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11
Q

Sputum Specimen Use and Challanges. When to use?

A

Normal flora always present so sample often contaminated (looking for a predominant organism)

  • Atypicals won’t stain
  • Use when suspect MRSA or P. Aeuroginosa
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12
Q

Blood Culture Use

A

Can be positive in patients with CAP but not routinely recommended unless severe CAP or empirically treated for MRSA or P. aeruginosa

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13
Q

Pleural Fluid Test

A
  • Can be cultured
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14
Q

Serology

A

> 4 fold rise in antibody titre (for specific pathogen such as M. pneumoniae

  • Conducted only 4 weeks apart
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15
Q

What is required for pneumona diagnosis?

A
  • Chext X-ray
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16
Q

Even if a patient can be treated as outpatient, they must be able to….

A
  • take oral fluids
  • comply with outpatient care
  • carry out activities of daily living
17
Q

Goals of Therapy for Pneumonae

A

Eradicate the micro-organism

Resolve signs and symptoms

Reduce risk of complications and hospitalization

Reduce risk of adverse events

Minimize the development of antimicrobial resistance

18
Q

Antibiotic Tx For Pneumonae Should be Started When

A
  • SHould be initiated promptly
  • Appropriate microbial smaples should be obtaines, but should not delay antibiotics
  • If viral, stop antibiotics
19
Q

Pathogens to Cover when TX

A
  • Strep Pneumonaie
  • Haemophilus Influenzae
  • Mycoplasma Pneumonaie
20
Q

Should fluorquinones be used?

A
  • NO
  • Broad spectrum –> Leads to more resistance
21
Q

CAP TX First Line No Comorbities and No risk for MRSA and P. Aeruginosa

A

Amoxicillin 1000mg tid (covers strep pnemoanie, hamophilus influenza (if a non-beta-lactmase producer, no coverage of mycoplasma pneumonaie however resolves on its own)

Doxycycline 100 mg BID (may be 200 mg for first dose, then 100 mg afterwards)

22
Q

First Line MAcrolides USage and Dosage

A
  • If pneumonnococo resistance is less than 25%

Clarithromycin 500 mg BID or 1000 mg Ex. Release OD

Azithromycin 500mg first day, then 250mg x 4 days OR 500mg daily x 3 days

23
Q

Risk Factors for MRSA and P. Aeuriginosa

A

Prior respiratory isolation of MRSA or P. aeruginosa or recent hospitalization AND receipt of parenteral antibiotics in last 90 days

24
Q

Comorbities Examples

A

chronic heart, lung, liver or renal disease, diabetes mellitus, alcoholism, malignancies, asplenia
Antibiotic within last 3 months (switch if large exposure to one class)

25
Q

Comorbities and No Risk for MRSA or P. Aeruginosa

A

Amoxicillin/clavulanate 500mg/125mg tid or 875mg /125 mg bid

Cefuroxime axetil 500mg bid

Cefprozil 500mg bid

Any one beta-lactam agent above plus…

Clarithromycin, azithromycin or doxycycline

OR monotherapy with
Levofloxacin 750 mg once daily for 5 days
Moxifloxacin 400mg once daily

26
Q

Duration of Tx

A

7-14 days

Min 5 days, be afebrile for 48-72hrs and otherwise clinically stable (exception: azithro 3 days)

5 DAYS –> CLINICAL STABILITY IS REACHED (HR, RR, OXYGEN SATURATION AND TEMP ARE NORMAL)

27
Q

If staph aereus or Ps. Aeuriginosa duration of tx

A
  • 7 days
28
Q

Tx of Strep. Pneumonaie

A

Penicillin G – 5 to 10 M units/d IV or IM

Oral Penicillin V or amoxicillin (often used if strep pneumonaie)

Alt: cefazolin or erythromycin (resistance) or FQ

29
Q

Strep Pneumonaie Charcateristically SYmptom

A

one shaking chill followed by a high temperature

30
Q

Strep pneumonaie penicllin resistance is often due to….

A

reduced affinity for PBP or change in amount of PBP present

31
Q

Penicillin resistant Strep. Pneumonaie. Route of Admin switch?

A

Low level resistance – penicillin IV (high dose) or amoxicillin (high dose) or cefuroxime

High level resistance – penicillin G 2MU IV q6h or cefotaxime or ceftriaxone or resp. FQ

When patient is afebrile for 2-3 days can switch to oral therapy

32
Q

Staph Aereus seen when, more common in, and result….

A

Increased incidence following influenza epidemics

More common in debilitated patients and CF

Can release enzymes and endotoxins which lead to empyema and abscess

33
Q

MSSA TX

A

Cloxacillin 8 to 12 g/d IV (up to 2g q4h)

Alt: cefazolin, clindamycin or vancomycin

34
Q

MRSA TX, Duration, and Length of TX

A

Vancomycin, linezolid, (tigecycline – little evidence for pneumonaie )

May take up to 3 weeks to see a response

Continue treatment for 14 to 21 days

Infectious Disease Therapeutics (17 decks)

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