Upper/Lower Respiratory Tract Infections Flashcards
Community Acquired Pneumonia
-No exposure to the healthcare system
Hospital Acquired Pneumonia
- Not incubating at the time of hospital admission and occurring 48 hours or more after admission
- Could also include patients coming from the community who have received IV abx within 90 of admission
Ventilator Associated Pneumonia
Occurring > 48 hours after endotracheal intubation
Outpatient treatment of CAP
Previously healthy + no risk for resistance:
- PO Amoxicillin
- PO Doxy (if B-lactam allergy)
- PO macrolide (azithro)
- Comorbidities:
- PO Amoxicillin/clav or cephalosporin plus macrolide
- PO respiratory quinolone
Inpatient treatment of CAP
- Non severe: IV b-lactam plus macrolide or respiratory FQ
- Severe: IV b-lactam plus macrolide or IV b-lactam plus respiratory FQ
- Give treatment longer in severe
Duration of abx for CAP
- Minimum of 5 days be could go a week
- Should be afebrile for 48-72 hours
When to switch from IV to PO
- Must be hemodynamically stable and improving clinically
- Able to tolerate PO medications
- Have normally functioning GI tract
Legionella
-Levofloxacin IV for 10-21 days
HAP empiric treatment
- ceftriaxone
- levo, moxi
- ampicillin/sulbactam
Pseudomonas recommendations
- Pip/tazo
- Cefepime
- Ceftazidine
Duration of abx
-7 days for VAP and HAP
HAP/VAP Treatment
- Cover for MRSA (vano or linezolid)
- PsA agent (cefeoime, pip/tazo
- de-escalate
Sinusitis
- Inflammation and or infection of the mucosal lining of the nasal passage and paranasal sinuses
- Usually viral
Sinusitis treatment
- Viral: decongestants, irrigation, mucolytics
- Bacterial: no decongestants or antihistamines
- Corticosteroids:
When are abx used for sinusitis
- Persistent symptoms >/ = 10 days w/o improvement
- Severe symptoms >/ = 3-4 days at the beginning of the illness
- Worsening symptoms after a typical upper respiratory infection
Sinusitis treatment
- Augmentin
- SE: diarrhea and rash
- High dose Augmentin recommended when severe infection, attendance at daycare, age <2 or >65, recent hospitalization, abx use in prior month, immunocomp.
- Duration: adults (5-7 days), kids (10-14 days)
Pharyngitis
- Inflammation of the pharynx
- Symptoms: sore throat, fever, erythema
Group A strep (pharyngitis) treatment
- Abx
- If adults get a neg RADT test do not treat
- If kid gets a neg RADT test take a throat culture
- Penicillin VK or Amoxicillin for 10 days
- Allergy to penicillin use 1st gen ceph or severe allergy use clinda or axithro
- Antipyretics/analgesics: acetaminophen or NSAID
OM signs and symptoms
- fluid in middle ear
- inflammation of mucosa of the middle ear
- ear pain
- ear drainage
- hearing loss
OM management
- vaccination (pneumococcal/influenza)
- abx only for acute OM
- PO acetaminophen or ibuprofen
Use abx for OM?
- 6-12 years plus mod-severe pain or temp
- 6-23 months plus non-severe bilateral acute OM
Treatment for OM
- First line: Amox, alternative is cefdinir
- Give augmentin if amox was previously given in 30 day history
treatment for COPD exacerbations
- inhaled bronchdilators
- oxygen/ventilatory support
- systemic corticosteroids (no mortality benefit)
- abx (no mortality benefit)
- salvage therapies (theophylline)
When to use abx for COPD exacerbation
- when the patient has dyspnea, increased sputum volume, increased sputum purulence
- have 2 symptoms if sputum purulence is one of them
- anyone who requires mechanical ventilation with a COPD exacerbation
- duration: 5-7 days
