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BCPS > Respiratory Tract Infections > Flashcards

Respiratory Tract Infections Flashcards

1
Q

Severe CAP (minor criteria)

A

> = 3: higher level care

RR >30
Pao2/Fio2 ratio <= 250
Multilobar infiltrates
Confusion/disorientation
Uremia (BUN >=20)
Leukopenia (WBC <4)
Thrombocytopenia (plt <100,000)
Hypothermia (<36 C)
Hypotension requiring aggressive fluids

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2
Q

CAP common organisms

A

Mycoplasma pneumoniae
Streptococcus pneumoniae
Haemophilus influenzae
Chlamydia pneumoniae
Legionella pneumoniae
Virus

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3
Q

CAP organisms in alcoholism

A

S. pneumoniae
anaerobes
gram-negative bacilli (K. pneumoniae)

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4
Q

CAP organisms in nursing home

A

S. pneumoniae
H. influenzae
Gram-negative bacilli
S. auerus

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5
Q

CAP organisms in COPD

A

S. pneumoniae
H. influenzae
M. catarrhalis

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6
Q

CAP organisms in postinfluenza

A

H. influenzae
S. aureus
S. pneumoniae

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6
Q

CAP organisms after exposure to water

A

Legionella

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6
Q

CAP organisms in HIV

A

Pneumocystitis jirovecii
S. pneumoniae
M. pneumoniae
Mycobacterium

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7
Q

Empiric CAP tx non-hospitalized pts, no comorbidities

A

Amoxicillin 1gm TID
Doxycycline
Macrolide if local resistance <25%

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7
Q

HAP organisms

A

S. aureus*
Pseudomonas aeruginosa*
Enterobacter spp
K. pneumoniae
Acinetobacter spp
Serratia marcescens
Escherichia coli
S. pneumoniae

*empiric tx should be active against

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8
Q

Empiric CAP tx non-hospitalized pts with comorbidities

A

COPD, diabetes, alcoholism, chronic renal/liver failure, CHF, malignancy, asplenia, immunosuppression

Respiratory FQ (Moxifloxacin or levofloxacin 750mg daily)
Macrolide OR doxycycline PLUS augmentin or cefpodoxime or cefuroxime

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9
Q

Empiric CAP tx inpatient with non-severe pneumonia

A

Respiratory FQ (Moxi or Levo)

Unasyn OR ceftriaxone OR ceftaroline
PLUS
Macrolide OR respiratory FQ

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10
Q

Empiric CAP tx inpatient with severe pneumonia necessitating ICU stay

A

Unasyn OR Ceftriaxone OR Ceftaroine

PLUS

Respiratory fluoroquinolone OR macrolide

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11
Q

Duration of CAP therapy

A

5 days
guided by clinical stability

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12
Q

CAP and risk factors for MRSA/P. aeruginosa

A
  1. Prior respiratory isolate for MRSA or P. aeruginosa
  2. Severe pneumonia and locally validated risk factors (ESPECIALLY hospitalization & IV ABX within past 90 days)

Add on vancomycin or linezolid (MRSA) or
zosyn, cefepime, ceftazidime, imipenem, meropenem, or aztreonam (p. aeruginosa)

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13
Q

Two anti-pseudomonal agents needed for HAP when

A

-Received ABX in last 90 days
-High risk of mortality (ventilator need, septic shock)
-Structural lung disease (bronchiectasis or cystic fibrosis)

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14
Q

Two anti-pseudomonal empiric tx for HAP/VAP

A

First agent: B-lactam: ceftazidime, cefepime, imipenem, meropenem, zosyn, aztreonam

Second agent: aminoglycoside, FQ (cipro or levo), polymyxin

15
Q

Single agent anti-pseudomonal for HAP/VAP

A

Zosyn
Cefepime
Levofloxacin
Imipenem
Meropenem

Use if pt does not meet criteria for 2 anti-pseudomonal agents

16
Q

Risk factors for MRSA in HAP

A

-Risk for MDR organisms
-MRSA incidence in hospital is >20%
-Pt high mortality risk (ventilator, septic shock)

17
Q

HAP/VAP duration of therapy

A

7 days

18
Q

Risk factor for MDR organisms in VAP

A

IV ABX within past 90 days
Hospitalization of >= 5 days before VAP
Septic shock
ARDS preceding VAP
Acute renal replacement therapy before VAP

19
Q

MRSA nasal screen in HAP/VAP

A

if MRSA respiratory infection in hospital is <10%, negative MRSA PCR indicates no empiric MRSA coverage needed

If >10%, still need empiric coverage

20
Q

Oseltamivir

A

Neuraminidase inhibitor - must start within 48 hours of symptoms. Symptoms resolve 1-1.5 day sooner

Treatment:
75mg BID x5 days
CrCl 31-60: 30mg BID
CrCl 11-30: 30mg daily

Prophylaxis:
75mg daily

AE: GI, CNS (anxiety, headache, insomnia)

21
Q

Zanamivir

A

Neuraminidase inhibitor - must start within 48 hours of symptoms. Symptoms resolve 1-1.5 day sooner

Treatment:
Two INHALATIONS BID x5 days

Prophylaxis:
Two inhalations daily

Can cause bronchospasm, cough - avoid in asthma or COPD

22
Q

Peramivir

A

Neuraminidase inhibitor - must start within 48 hours of symptoms. Symptoms resolve 1-1.5 day sooner

600mg IV x1
CrCl<50: 200mg x1
CrCl <30: 100mg x1

AE: diarrhea, elevations of liver enzymes, CPK, glucose

23
Q

Baloxavir

A

Endonuclease inhibitor

Treatment & Prophylaxis:
40-79kg: 40mg x1
>80mg: 80mg x1

aE: GI, bronchitis, HA

24
Q

Paxlovid dose decrease

A

CrCl 30-59 ml/min

25
Q

Hospitalized COVID treatment

A

Remdesivir 200mgx1 then 100mg daily x5 days

Dexamethasone 6mg PO or IV x10 days. Do not continue after discharge unless patient still on oxygen.

26
Q

Major symptoms of sinusitis

A

Purulent anterior nasal discharge
Purulent/discolored posterior nasal discharge
Nasal congestion, obstruction
Facial congestion, fullness
Facial pain/pressure
Hyposmia or anosmia
Fever

27
Q

Minor signs of sinusitis

A

HA
Ear pain, pressure, fullness
Halitosis (bad breath)
Dental pain
Cough
Fever
Fatigue

28
Q

Viral sinusitis

A

Clear nasal discharge - purulent possible on day 4-5
No fever
Peak symptoms days 3-6
Duration 5-10 days

29
Q

Bacterial sinusitis

A

Purulent nasal discharge for more than 10 days or early & severe
High temperature
Daytime cough
Persistent symptoms for >10 days, early & severe symptoms, or improved symptoms that then worsen
Usually >10 days duration

30
Q

Bacterial sinusitis first line therapy

A

Augmentin
High dose (90mg/kg/day or 2/0.125g) if severe infection, day care, <2 or >65, recent hospitalization, recent ABX in past month, or immunocompromised

31
Q

Bacterial sinusitis second line therapy

A

Doxycycline
Cefixime or cefpodoxime with clindamycin
Respiratory FQ
Intranasal saline irrigation
Intranasal corticosteroids (prolonged >15 days use)

32
Q

Bacterial sinusitis therapy duration

A

Adults: 5-7 days
Children: 10-14 days

33
Q

Bacterial sinusitis inpatient therapy

A

Children, all IV:
Unasyn, ceftriaxone (q12h), cefotaxime, levofloxacin

Adults:
Levaquin (po or iv), moxifloxacin (po or iv), ceftriaxone (q12-24), cefotaxime iv

34
Q

Bacterial sinusitis supportive care that is not recommended

A

oral steroids
oral antihistamines
oral/nasal decongestants

35
Q

Strep throat first line treatment

A

Child
Penicillin V 250mg PO BID-TID
Amoxicillin 50mg/kg daily (max 1g)
Benzathine Penicillin G (<27kg = 60,000 units IM x1)

Adult
Penicillin VK 250mg QID or 500mg BID
Amoxicillin 500mg BID
Penicillin 1.2 million units IM X1

10 days

36
Q

Strep throat treatment if penicillin allergic

A

Cefadroxil 30mg/kg daily
Cephalexin 20mg/kg/dose BID
Azithromycin 12mg/kg daily (5 days)
Clarithromycin 7.5mg/kg BID
Clindamycin 7mg/kg TID

37
Q

Strep throat supportive care

A

Do not give steroids
Do not give benzocaine to children
NSAID, tylenol

38
Q

Respiratory culture + gram stain needed in these groups

A
  • Severe disease
  • Empiric tx targeting MRSA/Pseudomonas
  • Prior history of MRSA or Pseudomonas
  • Hospitalization & IV antibiotics in past 90 days

BCPS (27 decks)

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