Week 2 Pneumonia

Question 1

The most common adult pathogens in pneumonia

Answer 1

S. pneumoniae (60-70%)
Viral pneumonia (18-36%)
M. pneumoniae (10-20%)
S. aureus (2%)
MRSA emerging pathogen

Question 2

Adult pneumonia pathogens with underlying lung disease

Answer 2

Unidentified (40%)
Nontypeable H. influenzae and M. catarrhalis (12%)
Determine most common pathogen in area

Question 3

How is pneumonia diagnosed?

Answer 3

Chest xray *gold standard*
High grade fever 
True chills
Cough
Sputum production 
Pleuritic chest pain 
Pulse oximetry < 90%
Physical exam: egophony, bronchophony

Caveat: elderly may not present with symptoms, monitor mental status

Question 4

List risk factors for pneumonia

Answer 4

COPD, diabetes, renal disease, malignancy, asplenia, age 65+, use of antibiotics in past 3 months

Question 5

First-line tx pediatric patients with pneumonia

Answer 5

Supportive care because 90% viral source
If bacterial, amoxicillin for immunized infants
For atypical organisms, i.e. M. pneumoniae or C. pneumoniae ~ macrolide
Tamiflu for moderate-severe CAP consistent with influenza (only within 2 days of signs/symptoms)

Question 6

Non-pharmacologic treatment for pneumonia

Answer 6

Adequate hydration
Rest
Supplemental oxygen in severe cases

Question 7

Candidates for empiric therapy for pneumonia

Answer 7

Previously healthy

No risk factors for drug-resistant CAP

Question 8

Empiric treatment for pneumonia

Answer 8

Macrolide

i.e. erythromycin, azithromycin or clarithromycin

Question 9

Antibiotic therapy in aspiration pneumonia

Answer 9

Augmentin or clindamycin

Question 10

Pneumonia antibiotic therapy co-infection with MRSA

Answer 10

doxycycline + bactrim, vancomycin, clindamycin, linezolid, ceftaroline

Question 11

First-line treatment for pneumonia in adults with comorbidities

Answer 11

1. Beta lactam or Augmentin
2. cefpodoxime, cefdinir, and cefuroxime + macrolide (doxycycline may substitute macrolide)
3. Fluoroquinolone alone

Length of treatment: min. 5 days and afebrile 48-72 hours

Question 12

Pneumonia antibiotic therapy in geographical areas showing macrolide-resistant S. pneumoniae

Answer 12

High-dose amoxicillin, Augmentin + macrolide or respiratory quinolone alone, i.e. moxifloxacin, gemifloxacin, levofloxacin

Question 13

Antiviral therapy for influenza pneumonia

Answer 13

Oseltamivir (Tamiflu) or zanamivir twice daily for 5 days (must be initiated within 2 days of signs and symptoms)

Question 14

When to order a CXR

Answer 14

At least one of the following:
Temp>100
HR>100
RR>20

Any patient with at least 2 of the following:
Decreased breath sounds
Crackles or rales
Absence of asthma

Question 15

When to decide to hospitalize

Answer 15

CURB 65 - if 2 or more criteria apply
Score 0-1: ok to treat as outpt
Score 2: consider short hospital stay and watch closely as outpt
Score 3-5: hospitalize with consideration of ICU care

Confusion 
Uremia (BUN > 20)
Respiratory rate > 30
Blood pressure, low (SBP<90,DBP<60)
65, age 65 or more