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Spring 2022: Therapeutics IV > Respiratory Tract Infections I (Kays) > Flashcards

Respiratory Tract Infections I (Kays) Flashcards

1
Q

What are the most common bacterial pathogens seen in CAP?

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Mycoplasma pneumoniae
  • Legionella pneumophila
  • Chlamydophila pneumoniae
  • Staphylococcus aureus
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2
Q

In what groups is Streptococcus pneumoniae-related CAP more prevalent/severe?

A
  • splenic dysfunction (removed or sickle cell)
  • diabetes
  • immunocompromised
  • chronic cardiopulmonary disease
  • chronic renal disease
  • HIV
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3
Q

What are the risk factors for drug-resistant S. pneumoniae (DRSP)?

A
  • extremes of age (<6 YO, >65 YO)
  • prior antibiotic therapy
  • underlying illnesses/comorbdities
  • daycare attendance or family of a child in daycare
  • recent/current hospitalization
  • immunocompromised, HIV, nursing home, prison
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4
Q

How is Mycoplasma pneumoniae CAP spread?

A

close person-to-person contact (especially enclosed populations like the military and dorms)

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5
Q

Mycoplasma pneumoniae CAP symptoms are usually _________ and ______________.

A

benign; self-limiting

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6
Q

How is Legionella pneumophila CAP spread?

A

inhalation of aerosols containing Legionella

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7
Q

What is, arguably, the most unique symptom associated with Legionella pneumophila CAP?

A

presence of high fevers (>104°F)

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8
Q

What CAP pathogen is most likely to appear in patients post-influenza?

A

Staphylococcus aureus

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9
Q

What are some symptoms associated with Staphylococcus aureus CAP?

A
  • sudden onset of shaking chills
  • pleuritic chest pain
  • productive cough
  • increased WBC with left shift
  • consolidation
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10
Q

What are some factors that may lead us to suspect a CAP patient has CA-MRSA?

A
  • concurrent/recent influenza infection with CA-MRSA (patient or close contact)
  • necrotizing pneumonia or cavitary infiltrates
  • ICU admission
  • rapid progression of symptoms
  • respiratory failure
  • empyema formation
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11
Q

What signs/symptoms are considered to be classic CAP presentation?

A
  • sudden onset of fever and chills
  • pleuritic chest pain
  • dyspnea
  • productive cough
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12
Q

Are CAP patients typically brachycardic or tachycardic?

A

tachycardic

relative bradycardia may indicate that the infection is viral or atypical

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13
Q

What are some indicators that a CAP patient is experiencing serious respiratory compromise?

A
  • tachypnea
  • cyanosis
  • use of accessory muscles for respiration
  • sternal retraction
  • nasal flaring
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14
Q

Evidence of consolidation in CAP is suggestive of ___________ infection.

A

bacterial

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15
Q

What events may be considered evidence of consolidation in CAP?

A
  • dullness to percussion
  • increased breath sounds
  • inspiratory crackles
  • increased tactile fremitus
  • whisper pectiloquy
  • egophany
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16
Q

What pathogen may be involved if a patient has rust-colored sputum?

A

S. pneumoniae

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17
Q

What pathogen may be involved if a patient has dark red, mucoid sputum?

A

K. pneumoniae

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18
Q

What pathogen may be involved if a patient has foul-smelling sputum?

A

mixed anaerobes

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19
Q

What pathogen is implicated if a patient’s Gram stain shows Gram (+), lancet-shaped diplococci?

A

S. pneumoniae

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20
Q

What pathogen is implicated if a patient’s Gram stain reveals small, Gram (-) coccobacilli?

A

H. influenzae

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21
Q

What are the components of CURB-65?

A
  • confusion
  • uremia
  • respiratory rate
  • (low) blood pressure
  • age >65
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22
Q

What CURB-65 range indicates that a patient needs outpatient treatment?

A

0-1

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23
Q

What CURB-65 score indicates that a patient may need admitted to a general ward?

A

2

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24
Q

What CURB-65 range indicates that a patient may require ICU care?

A

≥3

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25
Q

What CAP empiric therapy would you recommend for a healthy outpatient with no prior antibiotic use in the last 90 days?

A

amoxicillin

OR

doxycycline

can only use macrolides in areas with pneumococcal resistance <25% (which basically means you can’t use them at all)

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26
Q

What CAP empiric therapy would you recommend for an outpatient with comorbidities/has used antibiotics in the last 90 days?

A

respiratory FQ

OR

Augmentin/cefpodoxime/cefuroxime + macrolide

OR

Augmentin/cefpodoxime/cefuroxime + doxycycline

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27
Q

What empiric therapy would you recommend for an inpatient with non-severe CAP and no risk factors for MRSA or P. aeruginosa?

A

Unasyn/cefotaxime/ceftriaxone/ceftaroline + macrolide

OR

respiratory FQ

OR

Unasyn/cefotaxime/ceftriaxone/ceftaroline + doxycline (if contraindication for other regimens)

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28
Q

What empiric therapy would you recommend for an inpatient with severe CAP, but without risk factors for MRSA and P. aeruginosa?

A

Unasyn/cefotaxime/ceftriaxone/ceftaroline + macrolide

OR

Unasyn/cefotaxime/ceftriaxone/ceftaroline + respiratory FQ

29
Q

If an inpatient has CAP (severe or non-severe) and prior respiratory isolation of MRSA, what drug(s) should you add to their regimen?

A

vancomycin

OR

linezolid

30
Q

If an inpatient has CAP (severe or non-severe) and prior respiratory isolation of P. aeruginosa, what drug(s) should be added to their regimen?

A

Zosyn

OR

cefepime

OR

ceftazidime

OR

aztreonam

OR

carbapenem (mero- or imipenem)

31
Q

What drug should be added for adults with CAP who also test positive for influenza?

A

oseltamivir

32
Q

What is the appropriate duration of antibiotic therapy for patients with CAP who are improving?

A

should be continued until the patient is clinically stable, and for no less than 5 days

33
Q

Along with being afebrile for 48-72 hours, CAP patients should also demonstrate no more than 1 CAP-associated sign of clinical instability in order to discontinue antibiotic treatment after 5 days. What are these CAP-associated signs?

A
  • temperature ≤100.04
  • HR ≤100 bpm
  • RR ≤24 breaths/min
  • SBP ≥90 mmHg
  • arterial O2 saturation ≥90% or pO2 ≥60 mmHg on room air
  • ability to take PO medications
  • normal mentation
34
Q

What therapy options are preferred for CAP with penicillin-susceptible (MIC <2) Streptococcus pneumoniae?

A

penicillin G

OR

amoxicillin

35
Q

What therapy options are alternatives for CAP with penicillin-susceptible (MIC <2) Streptococcus pneumoniae?

A

macrolides

OR

cephalosporins

OR

respiratory FQs

OR

doxycycline

36
Q

What therapy options are preferred for CAP with penicillin-resistant (MIC ≥2) Streptococcus pneumoniae?

A

respiratory FQs

OR

ceftriaxone

OR

cefotaxime

37
Q

What therapy options are alternatives for CAP with penicillin-resistant (MIC ≥2) Streptococcus pneumoniae?

A

vancomycin

OR

linezolid

OR

high-dose amoxicillin (3 g/day)

38
Q

What therapy option is preferred for CAP with non-β-lactamase-producing Haemophilus influenzae?

A

amoxicillin

39
Q

What therapy options are alternatives for CAP with non-β-lactamase-producing Haemophilus influenzae?

A

respiratory FQs

OR

doxycycline

OR

macrolides

40
Q

What therapy options are preferred for CAP with β-lactamase-producing Haemophilus influenzae?

A

2nd/3rd generation cephalosporins

OR

Augmentin

41
Q

What therapy options are alternatives for CAP with β-lactamase-producing Haemophilus influenzae?

A

respiratory FQs

OR

doxycycline

OR

macrolides

42
Q

What therapy options are preferred for CAP with Mycoplasma and/or Chlamydophila pneumoniae?

A

macrolides

OR

doxycycline

43
Q

What therapy option is an alternative for CAP with Mycoplasma and/or Chlamydophila pneumoniae?

A

respiratory FQs

44
Q

What therapy options are preferred for CAP with Legionella pneumophila?

A

respiratory FQs

OR

azithromycin

45
Q

What therapy option is an alternative for CAP with Legionella pneumophila?

A

doxycycline

46
Q

What therapy options are preferred for CAP patients with MSSA?

A

nafcillin

OR

oxacillin

47
Q

What therapy options are alternatives for CAP patients with MSSA?

A

cefazolin

OR

clindamycin

48
Q

What therapy options are preferred for CAP with MRSA?

A

vancomycin

OR

linezolid

49
Q

What therapy option is an alternative for CAP with MRSA?

A

Bactrim

50
Q

What therapy options are preferred for CAP with anaerobes (aspiration)?

A

β-lactam/β-lactamase inhibitor combo

OR

clindamycin

51
Q

What therapy option is an alternative for CAP with anaerobes (aspiration)?

A

carbapenems

52
Q

What therapy options are preferred for CAP with Enterobacteriaceae?

A

3rd/4th generation cephalosporins

OR

carbapenems

53
Q

What therapy options are alternatives for CAP with Enterobacteriaceae?

A

β-lactam/β-lactamase inhibitor combo

OR

respiratory FQs

54
Q

What is omadacycline’s mechanism of action?

A

binds to 30S ribosomal subunit to block protein synthesis (bacteriostatic)

55
Q

What pathogens is omadacycline FDA-approved for?

A
  • MSSA
  • S. pneumoniae
  • H. influenzae
  • L. pneumophila
  • M. pneumoniae
  • C. pneumoniae
56
Q

True or false: omadacycline has coverage against Pseudomonas.

A

false

57
Q

What administration consideration is of note for omadacycline?

A

must give fasting (PO bioavailability is decreased with food)

58
Q

Does omadacycline need to be renally dose-adjusted?

A

no

59
Q

What is a major drug interaction for omadacycline?

A

di- and trivalent cations

60
Q

What is the recommended duration of treatment with omadacycline?

A

7-14 days

61
Q

What organisms does delafloxacin have in vitro activity against?

A
  • MRSA
  • S. pneumoniae and other streptococci
  • H. influenzae
  • M. catarrhalis
  • atypicals
  • E. coli
  • K. pneumoniae
62
Q

Does delafloxacin have coverage against Pseudomonas?

A

no

63
Q

What is lefamulin’s mechanism of action?

A

inhibits bacterial protein synthesis by binding to the peptidyl transferase center of the bacterial ribosome

64
Q

What pathogens does lefamulin cover?

A
  • S. pneumoniae
  • MSSA
  • H. influenzae
  • L. pneumophila
  • M. pneumoniae
    • C. pneumoniae
65
Q

Does lefamulin cover Pseudomonas?

A

no

66
Q

What major drug interaction should we be concerned about with lefamulin?

A

CYP3A4

67
Q

Does lefamulin need to be renally dose-adjusted?

A

no

68
Q

What advice would you give to a breastfeeding mother taking lefamulin?

A

pump and discard for the duration of treatment and for 2 days after the last dose

Spring 2022: Therapeutics IV (12 decks)

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