Pneumonia

Question 1

outpt pneumonia tx for a previously healthy person with no abx use in the past 3 months

Answer 1

Macrolide or doxycycline

Question 2

outpt pneumonia tx for macrolide resistant S. Pneumo or bx use within the past 3 months

Answer 2

Fluoroquinolone OR beta-lactam plus macrolide

• first line beta lactam choice: high dose amoxicillin or amox-clavulanate.
• *secondline: cephalosporin

Question 3

pneumonia tx for an inpt non-ICU

Answer 3

Fluoroquinolone OR anti-pneumococcal beta-lactam plus a macrolide

Question 4

CAP tx for inpt ICU

Answer 4

ANTI-PNEUMOCOCCAL B LACTAM plus Azithromycin or

ANTI-PNEUMOCOCCAL B LACTAM plus fluoro (aztreonam for PCN allergy)

Question 5

When to consider pseudo risk for ICU pt

Answer 5

EToH, CF, CA, organ failure, septic shock

Question 6

When to consider MRSA risk for ICU pt

Answer 6

End stage renal dz, IV drugs, prior abx, flu

Question 7

CAP tx for inpt with elevated pseudomonas risk

Answer 7

antipneumo/ antipseudo B lactam PLUS fluoro
OR
B lactam PLUS an AG PLUS azithro
OR
B lactam PLUS an AG PLUS fluoro
*aztreonam instead of B lactam for PCN allergy
*if MRSA risk: add vancomycin or linezolid

Question 8

Additional features in HAP

Answer 8

Fever, Purulent Sputum, Leukocytosis
*GET A GRAM STAIN CULTURE and use different Abx class for pts with recent use

Question 9

tx of HAP, VAP, HCAP including duration of tx

Answer 9

antipneumo antipseudo b lactam PLUS resp fluoro PLUS vanco or linezolid.
Tx for 14-21 days (7 if they respond to initial treatment) UNLESS it’s pseudomonas

Question 10

tx for pneumocystis jirovecii pneumoni

Answer 10

bactrim +/- dapsone

steroids for inflam

Question 11

tx for aspiration pneumonia

Answer 11

piperacillin/taxobactam