Pneumonia Flashcards
What do you need (3 things) to make the diagnosis of pneumonia?
- Sx
- Exam findings
- CXR (CANNOT dx pneumonia without an X-Ray!)
What is the typical distribution of pneumonia?
Asymmetric
How sick do the atypical pneumonias make you?
Usually not as sick, EXCEPT for legionella
What are the most common causes of community acquired pneumonia?
- S. Pneumo
- Atypicals
- Viruses
What causes regular community acquired pneumonia?
- S pneumo
- atypicals
- viruses
How do you treat regular community acquired pneumonia?
Azithromycin (Covers atypicals! Also covers gram positives and some gram negatives)
What organisms are your worried about in a CAP that is serious enough to be admitted to the ICU?
Staph
Strep pneumo
Viruses
If a pt acquired pneumonia from the hospital, what organisms are you worried about?
Staph and GNR. If acquired in the hospital, you’re not worried about atypical agents
What would you treat someone with CAP in the ICU?
Azithromycin + ceftriaxone (Ceftriaxone gives gram positive–(staph+strep) and negative coverage)
OR
Fluoroquinolone
What do you do if CAP in ICU becomes very severe?
Add vanco. You’re worried about resistant strep pneumo or staph
How do you treat ventilator acquired pneumonia?
Vancomycin and piperacillin/tazao
Vanc and ceftazidine
-Consider adding a quinolone to cover more GNR
How do you treat aspiration pneumonia?
Azithromycin+metro/clinda
What could cause treatment failure in pneumonia?
- empyema
- resistance
- metastatic infectin
- wrong dx
What do inflammatory cells release in pneumonia?
IFN-alpha, reactive O2, and IL-1
Major causes of CAP
mycoplasma pneumonia
s pneumo
chlamydophilia
Influenza
How do you treat pneumonia caused by seasonal influenza?
Osetamivir
Gardener with pneumonia
nocardia
Construction worker with pneumonia
aspergillus
Kid vaccine for s pneumo
prevnar (7 valent, conjugated)
Adult vaccine for s pneumo
pneumovax (23 valent, capsular)
Who should get pneumovax?
>65 CHF, COPD DM Alcoholic, cirrhotic pts CSF leak
Silver stain culture and metabolic acidosis are buzzwords for what pneumonia-causing agent?
legionella
What are the causes of atypical pneumonia?
RSV
Mycoplasma
Chlamydophilia
Why is ceftriaxone inadeuqte for CAP?
Doesn’t cover the atypicals
What is a good treat for pneumonia that is NOT resolving with ceftriaxone+azithromycin?
Levofloxacin. It covers gram +/-, AND atypicals.
Why is cipro a bad drug for pneumonia?
Because it does NOT cover strep pneumo. Mostly for gram negatives like in UTIs
Describe the very GENERAL coverage of 1. Vanco 2. Ceftriaxone 3. Cipro 4. Levo Azithro Meropenem
Vanco: Gram positives, and resistant Gm +
Ceftriaxone: Gm +/-
Cipro: Gm - and atypicals
Levo/Azithro: atypicals, gm +/-
Meropenem: Gm +/- but NOT atypicals. DOES cover pseudomonas
