Pneumonia

Question 1

CAP mild

Answer 1

Amoxycillin (O/1g/TDS) +/- Doxycycline (O/100mg/BD) 5-7 days

Question 2

CAP moderate

Answer 2

Benzylpenicillin (IV/1.2g/QID) + Doxycycline (O/100mg/BD) 7days

Question 3

CAP severe

Answer 3

Ceftriaxone (IV/1g/D) + Azithromycin (IV/500mg/D)

Question 4

CAP but penicillin rash?

Answer 4

Ceftriaxone (IV/1g/D) + Doxycycline

Question 5

CAP but anaphylaxis?

Answer 5

Moxifloxacin (O/400mg/D)

Question 6

HAP mild

Answer 6

Augmentin DF (O,875/125mg,BD)

Question 7

HAP moderate

Answer 7

Ceftriaxone (IV/1g/D)

Question 8

HAP severe + high risk resistant organisms

Answer 8

Tazocin (IV,4.5g,TDS)

Question 9

HAP severe with MRSA risk?

Answer 9

Tazocin + Vancomycin IV

Question 10

Aspiration Pneumonia mild

Answer 10

Amoxycillin (O,1g,TDS)

Question 11

Aspiration Pneumonia moderate

Answer 11

Benzylpenicillin (IV,1.2g,QID)

Question 12

Aspiration Pneumonia severe

Answer 12

Ceftriaxone (IV, 1g, D) + metronidazole (IV, 500mg, BD)
STEP DOWN Augmentin DF i BD

Question 13

Pneumonia: common pathogens bacteria and viral

Answer 13

○ Bacteria (32%)
			§ Streptococcus pneumoniae 14%
			§ Mycoplasma pneumoniae 9%
			§ Haemophilus influenzae 5%
			§ Legionella species 3%
			§ Moraxella catarrhalis 1%
		○ Virus (15%)
			§ Influenza 8%
			§ Picornaviruses 5%
			§ Respiratory Syncytial Virus 2%

Question 14

Pneumonia: typical vs. atypical AND severe disease?

Answer 14

- 'Typical’ bacteria= penicillins 
		○ Streptococcus pneumoniae (CXR lobar)
		○ Haemophilus influenzae
		○ Moraxella catarrhalis
	- ‘Atypical’ bacteria= doxycycline/azithromycin (CXR more diffuse bronchopneumonia)
		○ Mycoplasma pneumoniae
		○ Chlamydia (pneumonia, psittaci)
		○ Legionella
	- Other (mostly in severe disease)= ceftriaxone
		○ Staph aureus
		○ Gram negatives (Ecoli, Klebs) 
		○ Influenza

Question 15

Pneumonia severity stratification

Answer 15

CURB-65: 
Confusion
Urea > 7mmol/L
Resp rate >=30/min
BP (90/60mmHg)
Age > 65 yrs

Score 0-1 (home), 2(admit), >=3 (sever), >=4 (ICU)

Question 16

Trivia: Community acquired MRSA common in who? And how is it different compared to nosocomial MRSA?

Answer 16

IV drug users/ Indigenous Aussies/ Pacific Islanders

CAP MRSA more virulent than nosocomial MRSA b/c Panton-Valentine leucocidin (PVL) virulence factor.

Question 17

CAP tropical Australia, organisms? RFs? PTs with meliodosis need what?

Answer 17

Burkholderia pseudomallei (melioidosis) and Acinetobacter baumanii.
RF: Alcoholism, diabetes, Chronic renal failure, COPD

Meliodosis: Gram -ve bacilli in Ashdown’s medium. Need 3 m eradication therapy at least (Trimethoprim + sulfamethoxazole + doxycycline)