Pneumonia

Question 1

CAP Overview

Answer 1

BL PLUS MACROLIDE (or RESP QUINOLONE)

BL:
-Amox, Aug, Cefpodox, Cefurox, Doxy

Macro:
-Azithromycin, Clarithromycin

Resp FQ:
-Levo, Moxi, Gemi

Question 2

CAP: Outpatient + Healthy vs Comorbidities

Answer 2

Healthy: Amoxi, Doxy, mycins

Comorbidities:
-combo tx
-BL + macro or doxy
-or mono tx with RFQ

*include: HF, COPD, liver, renal, diabetes, cancer, alcoholism, abx use, hospitalization, 65+

Question 3

CAP: Inpatient, non-severe (general ward)

Answer 3

BL + macrolide

(dime, pime, zosyn, imi, mero = DIMPZ)

OR

-Resp FQ

Question 4

CAP: Inpatient, severe (ICU)

Answer 4

BL (tax, triax, amp)

PLUS

macrolide (preferred) or RFQ

Question 5

CAP: ICU pts with PCN allergy

Answer 5

FQ PLUS AZTREONAM

MRSA sus: add Vanco or Linez

Question 6

CAP: TX Duration

Answer 6

Mild/mod: 5-7 days

MRSA: 7-14 days

Question 7

CAP Prevention

Answer 7

Vaccination
-Pneumococcal 65+
-Influenza
-TDAP

Question 8

HAP and VAP DEF

Answer 8

Has to be 48 hours or more after hospital admission or intubation

Empiric: PM, SA, gram neg

Question 9

HAP Empiric TX: Not high risk and no MRSA risk

Answer 9

1 abx if no risk factors:
-Zosyn 4.5g
-Cefepime 2g
-Levo 750
-Imipenem 500
-Meropenem 1g
(PMILZ)

Question 10

HAP TX: Not high risk pt but MRSA risk

Answer 10

One of the following:
-zosyn, pime, levo, imi, mero, cipro, aztreonam (CAMILZ P)
PLUS
One of the following:
-vanco, linezolid

Question 11

HAP TX: High risk pt and MRSA risk (abx in last 90 days)

Answer 11

One of:
-CAMILZ, amikacin, gents, tobra
PLUS
One of:
-Vanco, linezolid

Question 12

VAP TX: no risk factors, < 10-20% MRSA

Answer 12

1 abx regimen

-zosyn, pime, levo, imi, mero

LIMPZ, taz, az

Question 13

VAP TX: no risk factors, but > 10-20% MRSA

Answer 13

2 abx regimen

-LIMPZ
PLUS
-vanco, line

Question 14

VAP TX: risk factors, > 10% gram neg resistance, or ICU unavailable susceptibilities

Answer 14

2 anti-PM from different classes

PM BL
-zosyn, pime, dime, mero, imi, azt
(DIMPZA)
PLUS
PM nonBL
-cipro, levo, ahminoglycosides, polymxin (CLAP)

DIMPZA + CLAP

**still add V/L if MRSA

Question 15

Bacterial Pneumonitis TX

Answer 15

-cough, fever, purulent sputum, insidious onset (days to weeks)

-clinda
-metro (not single)
-zosyn (if PM)
-carbas
-moxi
-amp
LAMMZC

1-2 weeks, 6-12 if abscess

Question 16

Acronyms

Answer 16

-CAP: MAD (OP, healthy), BL+M (OP, CM) and BL+M (dimpz vs tat for GW or ICU) and RFQ

-HAP: PMILZ, CAMILZ P VL, CAMILZ TAG VL

-VAP: LIMPZ at, LIMPZ VL, DIMPZA + CLAP