RTI 2 Flashcards
How is CURB score used?
CURB is used to determine tx of CAP.
Outpatient 0-1
Inpatient 2
ICU 3+
What does CURB stand for?
Confusion BUN >= 20 Respiratory Rate > 30 BP (SBP65 One point each
Describe Acute Bronchitis…
Mostly viral
Cough is most common symptom
Fever uncommon, but may occur
Cough + Fever suggests something else (flu or pn)
Tx with NSAID, APAP, ipratropium, and nasal decongestants
No proven benefit of Abx use in AB
Tx of CAP, outpatient with NO comorbidities…
Macrolide (Azithromycin,clarithromycin, erythromycin)
Alt. Doxy
Tx of CAP, outpatient with comorbidities…
FQL (levofloxacin, Moxifloxacin, gemifloxacin)
Beta-lactam (amoxicillin) plus macrolide
Tx of CAP, inpatient…
FQL
Beta-lactam PLUS macrolide
Tx of CAP, ICU…
Beta-lactam PLUS FQL
Beta-lactam PLUS azithromycin
Tx of HCAP, wih NO RFs for MDR pathogens…
Similar to CAP
Ceftriaxone or FQL or amp/sulbactam or ertapenem
Tx of HCAP, RFs for MDR pathogens…
Beta-lactam (cefepime, Ceftazidime, imipenem, meropenem, piper/tazo)
PLUS
Antipseudo FQL (cipro,levo) or Aminoglycoside
PLUS
Linezolid or Vancomycin
Tx of CAP aspiration pneumonia…
Clindamycin (DOC)
or
Amp/sulbactam, or Amox/clav, or pip/tazo
Tx of HCAP aspiration pneumonia…
Cefepime or Ceftazidime PLUS clindamycin or metronidazole
Or
Newer FQL plus clindamycin for PCN allergy
Vanc when MRSA is a concern
Why is cipro never used in RTIs?
It doesn’t cover strep pneumo
Which FQL does not cover pseudomonas?
Moxifloxacin
When do you use cipro in pneumonia pts?
When you need to cover pseudomonas
Tx for CAP if pseudomonas is a concern…
Antipseudomonal beta-lactam PLUS
Aminoglycoside PLUS
FQL -OR- Macrolide
Tx DUR for CAP…
At least 5 days
Pt should be afebrile for 48-72 hours
Should have no more than 1 CAP-associated sign of clinical instability before DC therapy
When can you switch from IV to PO in CAP?
Clinically improving (90, oral intake, normal mental status)
Common pathogens in CAP…
Strep. pneumo
M. pneumo
Atypical orgs
Inpatient - staph aureus
Common pathogens in HAP…
Pseudomonas
Enterobacter
Staph. aureus
Klebsiella
Most common MDR
Pseudomonas
Klebsiella
Enterobacter
ESKAPE
RFs for MDR pathogens
Abx within 90 days
ICU stay
High frequency Abx resistance in comm. or hospital
Hospitalization
How long is a pt in hospital before risk of MDR?
5+ days
Pip/tazo dose and use…
4.5g q 6 hr in MDR HAP
Levofloxacin dose and use
750 mg qdaily in MDR HAP
