URI antibiotics Flashcards
Outpatient CAP
previously healthy
Macrolide
Doxycycline
Pneumonia in Transplant pt most likely
Cytomegalovirus
RSV
Aspergillus
Mucormycosis
atypical p organisms
chalmydia pneumoniae
mucoplasma penumoniae
legionella pneumophilia
DOC for penuococcus
cefotaxime
ceftriaxone
(not cephalosporin)
FQ spectrum
intracellular atypicals (mycoplasma, chlamydia, legionella_
second line for some mybacterials (MTB, MAC)
treatment duration CAP
conditions
minimum 5 days
afebrile 48-72 hours, breathing without O2
(2 weeks for coagulase positive Staph or Pseudomonas)
for Penicillin resistant strep pneumo MIC > 2.0mcg/ml
for non-meningeal infection?
Vanco and rifampin
non-miningeal = cefotaxime/ceftriaxone,
high dose ampicillin
carbapenems
flouroquinolone (levofloxacin, moxifloxacin)
best anti-pneumoccocal FQ
levofloxacin
(also moxifloxacin)
in patient CAP if pseudomonas is considered
a-penumococcal, a-pseudomonal B lactam
(piperacillin, tazobactan, cefepime, meropenem)
PLUS
a-pseudomonal flouroquinalone
drugs for resistant gram positive bacteria
Vancomycin - not VRE (oral for c dif only)
**Linzezolid - **bone marrow suppression and neuropathy prolonged use
Daptommycin - not for use in pneumonia (bound by surfactant)
CURB criteria for pneumonia,
Confusion
BUN >19mg/dL
RR >30breaths/min
Systolic < 60
Age 65
0-1=home
2= home or short inpt
3-5 = Admit, consider ICU
Penicillin resistant (0.1<1.0)
treat with
high dose penicillin G or ampicillin,
cefotaxine /ceftriaxone
(otherwise pen G and amoxicill for MIC
Inpt, non-ICU CAP with not PCN allergy
with allergy?
Beta lactam plus macrolide
a-pneumoccocal flouroquinolone
inpatient, ICU CAP with no PCN allergy
with allergy
B-lactam plus macrolide
OR a pneumococcal floruroquinolone
a-penumoccoccal FQ
PLUS aztreonam
extra side effectsm flouroquinolines
tendonitis
profoudn hypoglycemia
Typical CAP organism
Strep pneumo
Haemophilus influenzae
Moraxella catarrhalis
pneumonia in early HIV infection most likely
Step pneumo
outpatient CAP
co-modbidities present
a-pneumococcal Flouroquinolone
B-lactam plus macrolide
linezolid interacts with
antidepressents > 5HT syndrome
most common causes of outpatient CA Pneumonia
Strep pneumo
mycoplasma pneumo
haemophilus influenzae
chlamydophila pneumo
resp viruses (influenza A+B, adenovirus, RSV, parainfluenza)
DOC CAP with aspiration
add clindamycin to cover oral anaerobes
General guidlines for emperic therapy
Typical,
Atypical
allergies
Typical = beta lactams
Atypical =Doxycycline or macrolides
For Beta lactam allergy, Flouroquinolones (levo, Moxi)
pneumonia with exposure to rabbits most likely
francisella tularensis
pneumonia with structural lung disease (cystic fibrosis, COPD, bronchiectasis)
Pesudomonas aeruginosa (esp Cystic fibrosis)
staph aureus
Non-tuberculous myobacteria
aspergillus
extra side effects cepalosporins
altered mental status
Tetracyclines spectrum (tetracycline, doxycycline, minocycline)
wide gram pos and gram negative strain
atypicals - mycoplasma, legionella, chlamydia
(tetracycline less effective, but cheaper)
(minocycline more lipophilic - skin, soft tissue, bone infection)
pneumonia with exposure to farm or parturient naimals
coxiella burnetti
(odd fever, infiltrate, cattle)
macrolides spectrum
(erythromycin, clarithromycin, azithromycin)
resp gram positive
gram nega
intracellular atypicals (mycoplasma, chalmydia, legionella)
pneumonia with exposure to birds
chlaymdophila pistacci (parrots)
avian influenza (poultry)
best antipseudomonal FQ
ciprofloxacin
(also levofloxacin)
late HIV infection Pneumonia (CD4
Pneuocystis jirovecii
Non=tuberculous myubacteria
Histoplasma
Empiric Abs for HCAP without multidrug resistant risk factors
ceftriaxone
amp/sulbactam
ertapenemm
Flouroquinolone
CAP if MRSA suspected
Add vancomycin or linezolid
hemoptysis + weight loss + homelessness =
tuberculosis
empiric antibioitic for HCAP with multidrug resistant risk factors
Anti-psuedomonal beta-lactam
PLUS
antipseudomondal fluroquinolone OR aminoglycoside
PLUS
Vanco or Linezolid if MRSA suspected
DOCs for invasive MSSA infections
drugs NOT indicated
(Nafcillin) Oxacillin, Cefalozin
NOT Quinolones (moxifloxacin,ciprofloxacin)
beta lactam categories
**penicillins **- cillin
cephalosporins - cef or ceph
carabpenems - ertapenenm, meropenem, imipenem
monobactams - aztreonam
**beta-lactamase inhibitors - **calvuloanic acid, sulbactam
DOC peusdomonas aeruginosa
piperacillin+Tazobactam
Ceftazadime
Cefepime
Meropenen..Imipenem
Aztreonam (mono bactam(
risk factors penicillin reisstant strep pneumo
>65
Beta lactam in last 3 months
alcoholism
comorbidities
exposreu to child in day care
most common inpatient, ICU CA pneumonia
S pneumonia
staph areus
legionalla
gram negative bacilli
H influenzae
risk factors for HCAP
hospitalization >5 days
acute care >2 days in past 90 days
nursing home/long term care facility
IV abxs, chemo, or wound care in past 30 days
chronic dialysis within 30 days
family member with multidrug resistant pathogen
do not treat abnormal x-rays with antibiotics if patient does not have evidence of
systemic inflammation (fever, WBC, sputum production)
most common inpatient, non-ICU CA pneumonia bacteria
Strep pneumonia
Mycoplasma pneunmonia
chlamydophila pneumonia
H influenze,
Legionalla
aspiration
Resp viruses (Flu A+B, adenovirus, RSV, parainfluenza
for multi drug resistant strep pneumo
Vanco and rifampin
clinadmucin, levofloxacin/moxfloxacin
linezolid
pneumonia with travel to SW US most likely
cocciciodes
Hanta virus (four corners, acute pulmonary syndrome)
