Pulmonary Flashcards
Acute Exacerbation of Chronic Bronchitis (outpatient-7)
3-10 day duration Azithro 500mg PO daily for 3 days Azitrho 500mg PO once then 250mg for 4 days Doxy 100mg PO BID Cefuroxime 500mg PO BID Levofloxacin 750mg PO daily for 5 days Moxifloxacin 400mg PO daily for 5 days Bactrim DS 1 tablet PO BID
Acute Exacerbation of Chronic Bronchitis (inpatient-5)
Ceftriaxone 1g IV once daily Moxifloxacin 400mg PO/IV once daily If Pseudomonas suspected: Levofloxacin 750mg PO/IV once daily Cefepime 2g IV TID Zosyn 4.5g IV QID
Cardinal symptoms of Acute Exacerbation of Chronic Bronchitis
Inc dyspnea, increased sputum volume, inc sputum purulence
Define Mild Acute Exacerbation of Chronic Bronchitis and why its relevant
only one cardinal symptom with no inc sputum purulence; may not need antibiotics
can adjunctively treat with Broncodilators, steroids, and inhaled beta 2 agonists
When would pseudomonas be suspected in Acute Exacerbation of Chronic Bronchitis
Bronchiectasis, multiple recent antibiotics, frequent hospitalizations, chronic oral steroid use
What risk factors/comorbidities define high risk CAP
Chronic heart, lung, liver, or renal disease, diabetes, alcoholism, active cancer, immunosuppression, use of IV antibiotics in prev 3 months
Treatment for low risk CAP (outpatient)
Amoxicillin 1g PO TID for 5-7 days or
Doxy 100mg PO BID for 5-7 days
Treatment for high risk CAP (outpatient)
Fluoroquinolone monotherapy
Levo 750mg PO daily for 5 days
Moxifloxacin 500mg PO daily for 5 days or
Augmentin 2g XR BID or Cefpodoxime 200mg BID or Cefuroxime 500mg BID PLUS Azithromycin 500mg PO once then 250mg for 4 days or Doxy 100mg PO BID for 5-7 days
Inpatient CAP treatment (non ICU)
Levo 750mg PO/IV or Moxi 400mg PO/IV once daily
or
Ceftriaxone 1g IV daily
plus
Azithromycin 500mg PO once then 250mg for 4 days or
Doxy 100mg PO BID for 5-7 days
Inpatient CAP treatment (ICU w/o pseudomonas risk)
Ceftriaxone 1g IV once daily and azithromycin 500mg IV once daily
If severe PCN allergy: Levo 750 IV once daily
If MRSA suspected ADD
Vanc 25-30mg/kg IV then 15-20mg/kg IV BID or
Linezolid 600mg PO/IV BID
Inpatient CAP treatment (ICU w/ pseudomonas risk)
Levo 750mg IV daily or Cipro 400mg IV TID or Gentamicin 5-7mg/kg IV AND Azithro 500 IV daily
Plus
Cefepime 2g IV TID or
Zosyn 4.5 g IV QID
If Severe PCN allergy:
Gentamicin 5-7 mg/kg IV daily PLUS
Levo 750mg IV once daily or
Aztreonam 2g IV TID AND Azithro 500 IV daily
If MRSA suspected ADD
Vanc 25-30mg/kg IV then 15-20mg/kg IV BID or
Linezolid 600mg PO/IV BID
Aspiration Pneumonia/Abscess
Unasyn 3g IV QID or
Ceftriaxone 1g IV daily and Flagyl 500mg IV BID or
Zosyn 4.5g IV TID or
Imipenem/Cilastin 1g IV TID
If severe PCN allergy:
Flagyl 500mg IV BID PLUS
Levo 750mg IV or Moxi 400mg IV daily
HCAP/VAP Risks
hospitalization >2 days over past 3 months, previous MDR pathogen, Home infusion within 30 days, immunosuppressed, dialysis within 30 days, IV antibiotics within 30 days, wound care within 30 days
HCAP/VAP treatment
1 drug from Category A, B, and C
Category A drugs for HCAP/VAP
Cefepime 2g IV TID
Zosyn 4.5g IV QID
Meropenem 1g IV TID
Imipenem/Cilastin 1g IV TID
If severe PCN allergy:
Aztreonam 2g IV TID
