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

Respiratory Tract Infections II (Kays) Flashcards

1
Q

What are the risk factors for HAP/VAP?

A
  • advanced age
  • severity of underlying disease
  • duration of hospitalization
  • endotracheal intubation
  • mechanical ventilation
  • presence of nasogastric tubes
  • AMS
  • surgery
  • previous
  • antimicrobial therapy
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2
Q

What is the predominant organism implicated in HAP/VAP?

A

P. aeruginosa

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3
Q

What are the factors associated with an increased risk of MDR VAP?

A
  • prior IV antibiotics within 90 days
  • 5+ days of hospitalization prior to occurrence of VAP
  • septic shock at the time of VAP
  • ARDS before VAP
  • acute RRT before VAP
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4
Q

What are the risk factors for MRSA HAP/VAP?

A
  • IV antibiotics in last 90 days
  • late onset
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5
Q

What should all empiric VAP regimens provide coverage for?

A
  • S. aureus
  • P. aeruginosa
  • other Gram (-) bacilli
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6
Q

In what situations would you use TWO antipseudomonal antibiotics for VAP?

A
  • risk factors for resistance
  • patient in an ICU where >10% of Gram (-) isolates are resistant to monotherapy
  • patient in an ICU where local resistance rates are unknown
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7
Q

What antipseudomonal β-lactams can be used empirically for VAP?

A

Zosyn

OR

cefepime

OR

ceftazidime

OR

carbapenems (mero- or imipenem)

OR

aztreonam

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8
Q

What antipseudomonal non-β-lactams can be used empirically for VAP?

A

fluoroquinolones (cipro- or levofloxacin)

OR

aminoglycosides

OR

polymyxins

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9
Q

What empiric therapy is recommended for HAP patients without high mortality risk and no MRSA risk factors?

A

Zosyn

OR

cefepime

OR

carbapenems (imi- or meropenem)

OR

levofloxacin

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10
Q

What empiric therapy is recommended for HAP patients with low mortality risk, but MRSA risk factors?

A

One of the following: Zosyn, cefepime, ceftazidime, imipenem, meropenem, levofloxacin, ciprofloxacin, aztreonam

PLUS: vancomycin or linezolid

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11
Q

What empiric therapy is recommended for HAP patients with high mortality risk or prior IV antibiotics in the last 90 days?

A

Two of the following: Zosyn, cefepime, ceftazidime, imipenem, meropenem, levofloxacin, ciprofloxacin, aztreonam, aminoglycoside

PLUS: vancomycin or linezolid

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12
Q

Why would aminoglycosides generally be pretty poor treatment for HAP/VAP?

A
  • poor lung penetration
  • nephro- and ototoxicity
  • associated with lower clinical response rates
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13
Q

Polymyxins aren’t highly desirable agents to use in HAP/VAP…what scenario would you reserve the use of these drugs for?

A

patients with high prevalence for MDR pathogens

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14
Q

What pathogen-specific treatment is recommended for MSSA HAP/VAP?

A

cefazolin

OR

nafcillin

OR

oxacillin

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15
Q

What pathogen-specific treatment is recommended for MRSA HAP/VAP?

A

vancomycin

OR

linezolid

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16
Q

Why can’t daptomycin be used for HAP/VAP with MRSA?

A

because it’s inactivated by surfactant

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17
Q

What pathogen-specific treatment is recommended for ESBL-producer HAP/VAP?

A

carbapenem

OR

ceftazidime/avibactam

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18
Q

What pathogen-specific treatment is recommended for MBL-producer HAP/VAP?

A

aztreonam + ceftazidime/avibactam empirically

OR

aztreonam alone if susceptible

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19
Q

What pathogen-specific treatment is recommended for KPC-producer HAP/VAP?

A

ceftazidime/avibactam

OR

meropenem/vaborbactam

OR

imipenem/cilastatin/relebactam

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20
Q

What pathogen-specific treatment is recommended for HAP/VAP with MDR P. Aeruginosa?

A

ceftolozane/tazobactam

OR

ceftazidime/avibactam

OR

imipenem/cilastatin/relebatam

OR

cefiderocol

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21
Q

What pathogen-resistant treatment is recommended for HAP/VAP with Acinetobacter species?

A

carbapenem OR Unasyn if susceptible

cefiderocol if resistant to either above agent

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22
Q

What is the recommended duration of treatment for HAP/VAP?

A

7 days

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23
Q

What is the etiology of acute bronchitis?

A

respiratory viruses (AKA, don’t use antibiotics, dumbass)

24
Q

What can be used for symptomatic acute bronchitis?

A

antitussives and/or antipyretics, adequate hydration

25
Q

What are the 3 cardinal symptoms of AECB (Anthonisen Criteria)?

A
  • increased cough/dyspnea (SOB)
  • increased sputum volume
  • increased sputum purulence
26
Q

Define chronic bronchitis.

A

presence of a chronic cough, productive of sputum on most days for at least 3 consecutive months, each year for 2 consecutive years

27
Q

What are increased PMNs indicative of in AECB?

A

continued bronchial irritation

28
Q

What bacteria are most commonly involved in AECB?

A
  • H. influenzae
  • S. pneumoniae
  • M. catarrhalis
  • Enterobacterales, P. aeruginosa (seen in end-stage COPD)
29
Q

What is the recommended treatment duration for AECB?

A

5-7 days

30
Q

With what antibiotics is the infection-free interval for AECB significantly longer?

A
  • fluoroquinolones
  • Augmentin
  • azithromycin
31
Q

What are the risk factors for AECB?

A
  • age
  • severity of illness
  • >4 exacerbations/year
  • cardiac disease
  • home oxygen use
  • antibiotic use in last 90 days
  • recent corticosteroids
32
Q

What would you give initially for uncomplicated AECB?

A

macrolide

OR

2nd/3rd generation cephalosporin

OR

doxycycline

OR

amoxicillin

OR

Bactrim

33
Q

What would you give initially for complicated AECB?

A

respiratory FQ

OR

Augmentin

34
Q

What would you give initially for complicated AECB with risk of P. aeruginosa infection?

A

antipseudomonal FQ

OR

Zosyn

if hospitalized, you should automatically be empirically covering Pseudomonas!!!

35
Q

What is the most common etiology for pharyngitis?

A

viruses

36
Q

What bacterial pathogen is most commonly implicated in pharyngitis?

A

Streptococcus pyogenes (group A, β-hemolytic)

37
Q

What are some marked signs and symptoms of pharyngitis?

A
  • sudden onset of sore throat/dysphagia
  • fever
  • pharyngeal hyperemia
  • tonsillar swelling (+/- exudates)
  • enlarged/tender lymph nodes
  • red, swollen uvula
  • petechiae on soft palate
38
Q

What is the preferred diagnostic test for pharyngitis?

A

rapid antigen detection tests (RADT)

39
Q

What therapies can be used for Group A streptococcal pharyngitis?

A

Penicillin V (drug of choice)

OR

amoxicillin (2nd line)

OR

1st/2nd generation cephalosporins

OR

macrolides

OR

clindamycin

OR

cefdinir

OR

cefpodoxime

40
Q

What is the recommended treatment duration for Group A streptococcal pharyngitis?

A

10 days (with a few exceptions)

41
Q

When can viral rhinosinusitis be diagnosed?

A

when signs and symptoms of acute rhinosinusitis are present <10 days and symptoms are not worsening

42
Q

When can acute bacterial rhinosinusitis be diagnosed?

A

clinical presentation + signs and symptoms >10 days

43
Q

What bacterial agents are implicated in ABRS?

A
  • H. influenzae
  • S. pneumoniae
  • M. catarrhalis
44
Q

What are the major symptoms of acute rhinosinusitis?

A
  • purulent nasal discharge
  • nasal congestion/obstruction
  • facial congestion/fullness
  • facial pain/pressure
  • hyposmia/onosmia
  • fever
45
Q

What is the 1st line empiric therapy for ABRS in children?

A

Augmentin

46
Q

What drug should be used in pediatric ABRS with type 1 β-lactam hypersensitivity?

A

levofloxacin

47
Q

What drug should be used in pediatric ABRS with non-type 1 β-lactam hypersensitivity?

A

clindamycin + cefixime OR cefpodoxime

48
Q

What therapy options are available for pediatric ARBS with risk for antibiotic resistance or failed initial therapy?

A
  • Augmentin
  • clindamycin + cefixime OR cefpodoxime
  • levofloxacin
49
Q

What therapy options are available for pediatric ABRS with severe infection that requires hospitalization?

A
  • Unasyn
  • ceftriaxone
  • cefotaxime
  • levofloxacin
50
Q

What is the 1st line initial empiric therapy for adult ABRS?

A

Augmentin

51
Q

What is the 2nd line initial empiric therapy for adult ABRS?

A

doxycycline

52
Q

What therapy would you recommend for adult ABRS with a β-lactam allergy?

A
  • doxycycline
  • levofloxacin
  • moxifloxacin
53
Q

What therapy would you recommend for adult ABRS with risk of resistance or failed initial therapy?

A
  • Augmentin
  • levofloxacin
  • moxifloxacin
54
Q

What therapy would you recommend for severe adult ABRS requiring hospitalization?

A
  • Unasyn
  • levofloxacin
  • moxifloxacin
  • ceftriaxone
55
Q

What is the recommended treatment duration for adult ABRS?

A

5-7 days

56
Q

What is the recommended treatment duration for pediatric ABRS?

A

10-14 days

Spring 2022: Therapeutics IV (12 decks)

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