Pneumonia

Question 1

4 bugs that cause typical pneumonia (because they give lobar consolidation and easily sampled)

Answer 1

Strep pneumoniae = most likely
S. aureus
- Not as common but lead to more serious disease 
H. influenzae
Moraxella cattarhalis

Question 2

4 bugs that cause atypical pneumonia

Answer 2

Mycoplasma pneumonia
Chlamydia pneumonia 
Legionella pneumonia
- Inpatient 
- Not as common, but lead to more severe disease

Question 3

How long can you be in the hospital and still get community acquired pneumonia?

Answer 3

48 hrs

Question 4

What is unique about mycoplasma pneumoniae?

Answer 4

Contagious
= “walking pneumonia” - you don’t get super sick, you’ll get better w/o treatment
Treat to get you feeling better faster

Question 5

5 risk factors for CA pneumonia

Answer 5

1. Aspiration (poor mental status)
   - Upper respiratory –> lower respiratory tract
2. Smoking
3. Alcohol
4. Age
5. Immunosuppression

Question 6

What is your first DRUG choice for healthy adults OUTPATIENT

Answer 6

1st = macrolide 
2nd = doxycyline (possible bugs have more resistance)

Question 7

Drug for CA pneumonia for patient with comorbities outpatient

Answer 7

1st = fluoroquinolone

2nd (allergies) = B lactam (amoxicillin) + macrolide

Question 8

Why don’t you give fluoro as your first choice for healthy adults outpatient?

Answer 8

Because increase the risk of patient becoming fluro resistance

Question 9

How do you treat pneumonia inpatient

Answer 9

1. Fluoro

2. B lactam + macrolide = ceftriaxone + azithromycin

Question 10

What are symptoms of aspiration pneumonia?

Answer 10

Cough & fever
Purulent sputum
Basilar crackles 
Slower onset
Cavity on CT

Question 11

What bugs could cause aspiration pneumonia?

Answer 11

POLYMICROBIAL
Anaerobes (from the stomach)
- Cause the cavitary lesion
Viridans strep

Question 12

Drugs for aspiration pneumonia

Answer 12

Clinda
- Only if not concerned about GN
- If you're mainly concerned about GP (non-vomiting aspiration) 
Amoxicillin/clavulanate 
- IV = ampicillin/sulbactam 
Amoxicillin/metronidazole
- Be careful about alcoholic history

Question 13

Bugs causing hospital acquired pneumonia

Answer 13

Strep pneumo
MSSA/MRSA
PSEUDOMONAS
Acinetobacter
E.Coli
Klebsiella

Question 14

Drugs to treat multi-drug resistant bugs for HA-pneumo

Answer 14

Anti-pseduo: (+vanco)
- Meropenem
- Pip-tazo
- Cefepime 
MRSA
- Vanco
- Linezolid 
- Ceftaroline