Treatment of Respiratory Infections including TB

Question 1

CAP is most common in which groups

Answer 1

males
elderly
alcoholics
chronic disease

Question 2

What causes 60-80% of CAP?
10-20%
10-20%?

Answer 2

conventional bacteria
atypical bacteria
viruses

Question 3

What are the most common organisms associated with CAP

Answer 3

S. pneumoniae
H. influenzae

M/pneumoniae
C.pneumoniae
L.pneumoniae

Question 4

What microbiological investigations should be carried out in CAP

Answer 4

sputum analysis and culture
immunofluorescence on sputum analysis
blood cultures
urinary pneumococcal and legionella antigen

Question 5

List the severe CAP criteria

CURB 65

Answer 5

confusion (MMT <8)
urea >7mmol/l
resp rate >30/min
blood pressure <90 systolic or <60 systolic 
65 or above years

Question 6

If they have low-severity CAP, what antibiotics are they given?

Answer 6

amoxicillin OR
doxycycline

if no oral then IV amoxicillin or cefuroxime if allergic

severe allergy: ciprofloxacin and vancomycin

Question 7

If they have moderate CAP, what antibiotics are given

Answer 7

Same as in low severity but for 7 days instead of 5

Question 8

If they have severe CAP, what antibiotics are given

Answer 8

co-amoxiclav and clarithromycin for 10 days

if allergic or MRSA
levofloxacin and vancomycin

14-21 days for legionella, staph or gram negative pneumonia

Question 9

In influenza (viral pneumonia) 
= LRTI

symptoms: hypoxarmia, severe dyspnoea, inflitrates CXR

need a throat or deep nose swab in VTM for PCR

What is the treatment

Answer 9

oseltamavir 5 days

commence antibiotics

review with results and stop anti-viral therapy if negative

Question 10

What does rifampicin do

is it bactericidal?

Answer 10

inhibits mycobacterial RNA polymerase

YES

Question 11

What does isoniazid do, is it bactericidal

Answer 11

?inhibit cell wall mycolic acid synthesis

YES

Question 12

What does pyrazinamide and what is its role

Answer 12

unknown

sterilises inflammatory tissue

Question 13

Ethambutol what does it do
most important side effect
is it bactericidal

Answer 13

inhibits synthesis of cell wall polysaccharides
optic neuritis
YES

Question 14

Streptomycin
what does it do
is it bactericidal
principle side effect

Answer 14

binds to ribosome and inhibits protein synthesis
YES
ototoxicity

Question 15

What is involved in two-phase therapy

Answer 15

‘bactericidal’ phase - majority of organisms are killed

‘sterilising phase’ - persisting organisms killed

Question 16

what are the four principles of chemotherapy

Answer 16

two phase therapy
combination therapy
intermittent and minimum 6 month duration therapy

bacterial confirmation and susceptibility testing is done whenever possible

Question 17

What is the standard therapy for anti-TB regimen

Answer 17

rifampicin, isoniazid, pyrazinamide and ethambutol for 2 months

rifampicin and isoniazid for 4 months

Question 18

What is DOT

Answer 18

programme used by nurses to directly observe all doses being taken

Question 19

What infection can increase risk of drug-resistant TB

Answer 19

co-existing HIV infection

Question 20

What is the management for MDR TB

Answer 20

initial treatment with at least 4 likely sensitive drugs, to sontinue 3-6 months after sputum becomes culture negative

continued with three drugs for 15-18 months

surgery may be necessary

Question 21

What other measures are taken for MDR TB

Answer 21

notification
infection control
contact tracing and chemoprophylaxis