Treatment of respiratory infections including TB

Question 1

Which bugs can cause CAP

Answer 1

A pneumoniae
H influenza 
M pneumoniae
C pneumoniae
L pneumophila

Question 2

How to investigate CAP

Answer 2

Confirm diagnosis
Assess severity
Define etiological agent
Identify complications

Question 3

Microbiological investigations

Answer 3

Sputum analysis and culture
Immunofluorescence on sputum samples
Blood cultures
Urinary pneumococcal; and legionella antigen

Question 4

Criteria for Severe CAP

Answer 4

Confusion (mini mental test score of 8 or less)

Urea > 7mmol/l

Respiratory rate >30 p/min

BP: Systolic BP <90mmHg or diastolic BP <60 mmHg

65 or more years old

CURB65

Question 5

Treatment of low severity CAP

Answer 5

Amocicillin qds for 5 days

If severe allergy to penicillin then ciprofloxacin

Question 6

What is used to treat TB

-Side effects

Answer 6

Rifampicin
-Inhibits mycobacterial RNA polymerase

-Hepatitis, rash, fever, ‘flu syndrome’ and multiple drug interactions

Question 7

Mode of action of isoniazid

Side effects

Answer 7

Inhibits cell wall mycelia acid synthesis

Hepatitis, peripheral neuropathy and cutaneous hypersensitivity

Question 8

Mode of action of pyrazinamide

Answer 8

Sterilising inflammatory tissue

Hepatitis, anorexia, flushing, cutaneous hypersensitivity and hyperuricaemia

Question 9

Mode of action of ethambutol

Side effects

Answer 9

Inhibits synthesis cell wall synthesis

Optic neuritis

Question 10

Mode of action of streptomycin

Answer 10

Binds to mycobacterial ribosome and inhibits protein synthesis

Question 11

What is two phase therapy

Answer 11

Initial- bacteriacidal

NExt- sterilising phase