Pneumonia

Question 1

Meningitis

Answer 1

<1 month:
-ampicillin, ceftazidime/cefepime +/- gent

1 month - 50 years:
-CTX + vancomycin

50+ or immunocompromised:
-ampicillin, CTX, vancomycin

Question 2

CAP: Outpatient

Answer 2

Bugs:
-S. pneumoniae
-H. influenzae
-M. pneumoniae

TX:
-Healthy: amoxicillin 1g TID x5d, doxycycline, azithromycin/clari if <25% local resistance
-High risk: augmentin or cefpodoxime plus macro/doxycycline, OR moxifloxacin/levofloxacin 750mg qd x5d
(aug 875mg BID x5d + azi 500 mg x3d)

Question 3

CAP: Inpatient

Answer 3

GM:
-CTX + macrolide or doxycycline
-Moxi/levofloxacin

ICU:
-CTX + macrolide
-CTX + FQ (no mono FQ here)

Hx or hos/abx use in past 90d:
-MRSA: vancomycin or linezolid
-Pseudomonas: zosyn, cefepime, meropenem

Question 4

HAP/VAP

Answer 4

48+ hrs after hospitalization/ventilation

All PM/MSSA coverage:
-Cefepime
-Zosyn
-Levofloxacin

MRSA +/- vancomycin/linezolid

Question 5

TB

Answer 5

RIPE = all increase LFTS

Rifampin: hemolytic anemia, red bodily fluids

Isoniazid: hepatitis, peripheral neuropathy (Vit B6)

Pyrazinamide: gout

Ethambutol: optic neuritis, confusion/hallu

Question 6

Endocarditis

Answer 6

Emp Tx: vancomycin + ctx

+ gentamicin for synergy in more serious/difficult cases

Rifampin if bacteria with biofilm on prosthetic valves (can penetrate)

4-6 week duration