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PHRM 865 > 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
What are the 3 cardinal symptoms of AECB (Anthonisen Criteria)?
* increased cough/dyspnea (SOB) * increased sputum volume * increased sputum purulence
26
Define chronic bronchitis.
presence of a chronic cough, productive of sputum on *most* days for at least 3 consecutive months, each year for 2 consecutive years
27
What are increased PMNs indicative of in AECB?
continued bronchial irritation
28
What bacteria are most commonly involved in AECB?
* *H. influenzae* * *S. pneumoniae* * *M. catarrhalis* * Enterobacterales, *P. aeruginosa* (seen in end-stage COPD)
29
What is the recommended treatment duration for AECB?
5-7 days
30
With what antibiotics is the infection-free interval for AECB *significantly* longer?
* fluoroquinolones * Augmentin * azithromycin
31
What are the risk factors for AECB?
* age * severity of illness * \>4 exacerbations/year * cardiac disease * home oxygen use * antibiotic use in last 90 days * recent corticosteroids
32
What would you give initially for uncomplicated AECB?
macrolide OR 2nd/3rd generation cephalosporin OR doxycycline OR amoxicillin OR Bactrim
33
What would you give initially for complicated AECB?
respiratory FQ OR Augmentin
34
What would you give initially for complicated AECB with risk of *P. aeruginosa* infection?
antipseudomonal FQ OR Zosyn *if hospitalized, you should automatically be empirically covering Pseudomonas!!!*
35
What is the most common etiology for pharyngitis?
viruses
36
What bacterial pathogen is most commonly implicated in pharyngitis?
*Streptococcus pyogenes* (group A, β-hemolytic)
37
What are some marked signs and symptoms of pharyngitis?
* sudden onset of sore throat/dysphagia * fever * pharyngeal hyperemia * tonsillar swelling (+/- exudates) * enlarged/tender lymph nodes * red, swollen uvula * petechiae on soft palate
38
What is the preferred diagnostic test for pharyngitis?
rapid antigen detection tests (RADT)
39
What therapies can be used for Group A streptococcal pharyngitis?
Penicillin V (drug of choice) OR amoxicillin (2nd line) OR 1st/2nd generation cephalosporins OR macrolides OR clindamycin OR cefdinir OR cefpodoxime
40
What is the recommended treatment duration for Group A streptococcal pharyngitis?
10 days (with a *few* exceptions)
41
When can viral rhinosinusitis be diagnosed?
when signs and symptoms of acute rhinosinusitis are present \<10 days and symptoms are not worsening
42
When can acute *bacterial* rhinosinusitis be diagnosed?
clinical presentation + signs and symptoms \>10 days
43
What bacterial agents are implicated in ABRS?
* *H. influenzae* * *S. pneumoniae* * *M. catarrhalis*
44
What are the major symptoms of acute rhinosinusitis?
* purulent nasal discharge * nasal congestion/obstruction * facial congestion/fullness * facial pain/pressure * hyposmia/onosmia * fever
45
What is the 1st line empiric therapy for ABRS in children?
Augmentin
46
What drug should be used in pediatric ABRS with type 1 β-lactam hypersensitivity?
levofloxacin
47
What drug should be used in pediatric ABRS with non-type 1 β-lactam hypersensitivity?
clindamycin + cefixime OR cefpodoxime
48
What therapy options are available for pediatric ARBS with risk for antibiotic resistance or failed initial therapy?
* Augmentin * clindamycin + cefixime OR cefpodoxime * levofloxacin
49
What therapy options are available for pediatric ABRS with severe infection that requires hospitalization?
* Unasyn * ceftriaxone * cefotaxime * levofloxacin
50
What is the 1st line initial empiric therapy for adult ABRS?
Augmentin
51
What is the 2nd line initial empiric therapy for adult ABRS?
doxycycline
52
What therapy would you recommend for adult ABRS with a β-lactam allergy?
* doxycycline * levofloxacin * moxifloxacin
53
What therapy would you recommend for adult ABRS with risk of resistance or failed initial therapy?
* Augmentin * levofloxacin * moxifloxacin
54
What therapy would you recommend for severe adult ABRS requiring hospitalization?
* Unasyn * levofloxacin * moxifloxacin * ceftriaxone
55
What is the recommended treatment duration for adult ABRS?
5-7 days
56
What is the recommended treatment duration for pediatric ABRS?
10-14 days

PHRM 865 (59 decks)

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