Pneumonia

Question 1

What are the hallmark signs and symptoms of pneumonia?

Answer 1

** Cough and fever

May also include:
- cough with sputum
- shortness of breath
- fatigue

Question 2

What is the Gold Standard diagnostic tool for outpatient pneumonia?

Answer 2

Tool: Chest x-ray
Orientation: PA & Lateral
Findings: Opacity, infiltrates, or consolidation

Question 3

What is the most common pneumonia organism?
Is it Gram + or Gram - ?

Answer 3

Streptococcus pneumonia

Gram +

Question 4

What is the antibiotic with the strongest/best evidence for treating adult pneumonia in the general population?

What are the dosing details?

Answer 4

Amoxicillin 1 gram TID

Question 5

What antibiotics (and dosing) are recommended to treat adult pneumonia in the general population?

Answer 5

• Amoxicillin 1 gram TID
• Doxycycline 100 mg BID
• If local resistance < 25%, a macrolide:
  • Azithromycin 500 mg x 1, 250 mg daily
  • Clarithromycin 500 mg BID
  • Clarithromycin ER 1 gram daily

Question 6

What is the length of antibiotic treatment for adult pneumonia?

Answer 6

5 - 10 days

Question 7

What is the action to take if fever (or severe s/s) are present after 3 days on an antibiotic for pneumonia?

Answer 7

Change the antibiotic

Question 8

What are the instructions and rationale (exceptions) for doxycycline?

Answer 8

• No use in pregnancy to prevent discoloring the baby’s tooth enamel
• Take with food to avoid GI upset
• No milk Products within 2 hours to improve absorption
• Avoid prolonged sun exposure to reduce the risk of photosensitivity

Question 9

When does pneumonia require a post-treatment follow-up x-ray?

Answer 9

Only if fever/symptoms persist after 5-7 days on antibiotics

Question 10

What are the pneumonia vaccine age/at-risk groups?

Answer 10

> /= 65 years old

19 - 64 years at increased risk:
- Smoker
- COPD
- CV (except hypertension)
- Liver disease
- Asthma
- Diabetes

19 - 64 years at high risk:
- CSF leak
- Immunocompromised
- Cochlear implant
- Asplenia

Question 11

What conditions are considered comorbidities in the treatment of adult pneumonia?

Answer 11

Alcoholism

Chronic conditions:
- Heart
- Lung
- Liver
- Kidney

Malignancy

Asplenia

Diabetes

Question 12

What is the recommended antibiotic class for monotherapy for pneumonia in adult patients with comorbidities?

Answer 12

Respiratory quinolones:

Levofloxacin 750 mg daily
Moxifloxacin 400 mg daily
Gemifloxacin 320 mg daily

Question 13

What are the contraindications for the use of a respiratory quinolone?

Answer 13

Pregnancy

History of QT interval prolongation

Abdominal Aortic Aneurysm

Creatinine Clearance < 30 ml/min

Dehydration

Question 14

What antibiotics are recommended for combination therapy for comorbid adult patients with pneumonia?

Answer 14

A beta lactam antibiotic and either:

• Doxycycline or
• A macrolide antibiotic

Question 15

What are the beta lactam antibiotics and their doses for combination therapy for pneumonia?

Answer 15

Amoxicillin/clavulanic acid 1 gram TID or

A cefalosporin:

• Cefpodoxime 200 mg BID
• Cefuroxime 500 mg BID