Pneumonia Flashcards
Primary care setting what pneumonia is important to know?
Community acquired
Vaccines for Pneumonia
PPSV - We still give PCV13 Now, New
Rules for Vaccine
Age 65 or older for all adults 19-64 with chronic illnesses - CVD, Hep B,C, Asthma. Immunocompromised get second dose in five years. For those receiving vaccine before age 65, due to category 2 or 3, they get another at age 65 if five years has past.
Bacterial Pneumonia Bugs Most Common
Streptococcal pneumonia - most likely to kill patient. Mycoplasma pneumoniae - Walking pneumonia. Chlamydaphila Pneumoniae
Mycoplasma and Chlamydophila pneumoniae are…
Atypical pneumonia’s - Most common in young and middle adults.
If a patient is otherwise healthy, and has had no ABX in the last 60 days….
Treat with a Macrolid like…. Azithromycin Clarithromycin Erythromycin
If co-morbidities or antibiotics in the last 90 days..
Suspect drug resistant Strep pneumo - DRSP
What medication for atypical pneumonia?
Macrolide like: azithtomycine, or clarithromycin. Or Doxycycline (tetracyclines) Guidelines restrict use of quinilones for atypical pneumonia. Reserve for DRSP.
What 3 Quinolones are used to treat DRSP?
gemifloxacin (Factive) levofloxacine (Levaquin) Moxiflocxacin (Avelox) Note: Quinolone’s kill bugs above the waist.
If DRSP is suspected and Pt is allergic to Quinolone medication?
Use two ABX for treatment. Give a Beta-lactam medication PLUS macrolide or doxycyline. Beta-lactam is any PCN or cephalosporin.
How long to give an antibiotic?
Give three more days after they are no longer clinically stable i.e in pneumonia about 10 days.
How long is treatment if pt has no clinical instability?
48-72 hrs Azithromycin has long half life so < 5 days is ok.
When to get a CXR?
not necessary if responding to tx. Consider f/u in 7-12 weeks iff >40 or smoker, and always CXR if smoker.
What is hospital admission guideline CRB-65 (pneumonia severity index).
C = Confusion R = RR>/= 30min. B = BP/= 65 yo or 55 w/other sx’s
