Therapy of Pneumonia Flashcards
Pneumonia is one of the most common causes of:
1) Severe sepsis
2) Infectious cause of death
Pneumonia’s clinical manifestations are most severe in:
1) The very young
2) The elderly
3) The chronically ill
The most prominent pathogen causing community-acquired pneumonia (CAP) in otherwise healthy adults is:
Streptococcus pneumoniae
Streptococcus pneumoniae causes:
Community-acquired pneumonia (CAP)
What are some other common pathogens (besides Strep. pneumoniae)?
1) H. influenzae
2) Atypical pathogens:
a) Mycoplasma pneumoniae
b) Legionella sps
c) Chlamydia pneumoniae
3) Viruses, including influenza viruses
The leading causative agents in hospital-acquired pneumonia (HAP) are:
1) Gram-negative aerobic bacilli
2) S. aureus
3) Multidrug-resistant (MDR) pathogens
Ventilator-associated pneumonia (VAP) is
associated with:
Multidrug-resistant (MDR) pathogens
In pneumonia that follows the aspiration of gastric or oropharyngeal contents, ____ are the most common etiologic agents.
Anaerobic bacteria
Pneumonia in infants and children is caused mostly by:
Viruses
Which viruses can cause pneumonia in infants and children?
1) RSV
2) Parainfluenza
3) Adenovirus
____ is an important pathogen in older children.
Mycoplasma pneumoniae
Beyond the neonatal period, what are the top 3 pathogens in order?
1) Strep. pneumoniae
2) Group A Streptococcus
3) Staph. aureus
Why has H. influenzae type b become an infrequent cause of
pneumonia?
Because of the introduction of active vaccination against it
Supportive care for pneumonia?
1) Humidified oxygen for hypoxemia
2) Bronchodilators when bronchospasm is present
3) Chest physiotherapy and postural drainage with evidence of retained secretions
4) Adequate hydration
5) Optimal nutritional support
6) Control of fever
Recommendations are generally for __(specific/class of) antibiotics rather than for a specific drug.
Class of
Recommendations for the management of CAP in adults depend on:
1) The treatment setting: inpatient or outpatient
2) The severity of infection
3) The presence of comorbidities
4) The presence of risk factors for drug-resistant pathogen
All patients with CAP should be treated __ for bacterial infection.
Empirically
Any patient with CAP who was recently exposed to one class of antibiotics should be treated using:
A different class
Risk factors for MRSA and P. aeruginosa include:
1) Prior respiratory isolation of the pathogen
2) Hospitalization with administration of parenteral antibiotics within the last 3 months
3) Locally validated risk factors for these pathogens and prevalence of MRSA or P. aeruginosa in CAP patients
In outpatient settings of CAP pneumonia, patients without comorbid conditions or risk
factors for drug-resistant pathogens should take:
Monotherapy with Amoxicillin, Doxycycline, or a Macrolide (Azithromycin or Clarithromycin)
Macrolide monotherapy has shown resistance and should not be used if the local rate of
resistance of Pneumococcus is greater than __%.
25%
In outpatient settings of CAP pneumonia, patients with comorbid conditions or risk
factors for drug-resistant pathogens should take:
1) Monotherapy with a respiratory Fluoroquinolone
(Levofloxacin, Moxifloxacin, or Gemifloxacin)
OR
2) Combination therapy with (Amoxicillin-Clavulanate or a Cephalosporin) + (A Macrolide
or Doxycycline)
Inpatient setting of CAP pneumonia patients recommendations are based on:
1) Severity of pneumonia
2) Prior respiratory isolation of MRSA or P. aeruginosa
3) The presence of risk factors for these pathogens
For inpatients with non-severe pneumonia use:
1) Beta-lactam + Macrolide
OR
2) A respiratory Fluoroquinolone alone.
Alternative treatment for inpatients with non-severe pneumonia?
Beta-lactam + Doxycycline
For inpatients with severe pneumonia, use:
Beta-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) + A macrolide (azithromycin) or a Fluoroquinolone
Don’t use ___ for Acinetobacter VAP
Tigecycline
Acinetobacter HAP/VAP = use:
Carbapenem or Ampicillin/sulbactam
Resistant Acinetobacter HAP/VAP = use:
Inhaled Polymyxin B AND IV Colistin
