Term
| What is the single most sensitive & specific sign of severe pneumonia in adults? |
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Definition
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Term
| What PSI (pneumonia severity of illness score) requires hospital admission? does not require hospital admission? |
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Definition
| PSI > 90 requires hospital admission. |
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Term
How long should Abx treatment last outpatient?
Inpatient?
Severe legionnaires?
Bacteremic aerobic gram(-) pneumonia ?
Pseudomonas aeruginosa ? |
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Definition
How long should Abx treatment last outpatient - 5 days
Inpatient - if respond within 48 hours, 10 days
Severe legionnaires - 21 days
Bacteremic aerobic gram(-) pneumonia - 14 days
Pseudomonas aeruginosa - 21 days |
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Term
| Aspiration pneumositis - when does it require Abx therapy? DOC for when indicated? |
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Definition
| Not necessary unless: Poor dental hygiene, putrid sputum, alcoholics Treat with DOC: metronidazole Others: clindamycin, beta lactams, carbapenems, fluoroquinolones |
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Term
Initial treatment:
PSI < 90 and NOT hypoxemic, and previously healthy ? |
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Definition
Initial treatment:
PSI < 90 and NOT hypoxemic, and previously healthy:
po macrolide or doxycycline po |
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Term
Initial treatment:
PSI < 90 and NOT hypoxemic, and co-morbidities such as diabetes, alcoholism, immunosuppressive conditions, use of Abx in last 3 months, CKD, lung or cardiac disease ? |
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Definition
PSI < 90 and NOT hypoxemic, and co-morbidities such as diabetes, alcoholism, immunosuppressive conditions, use of Abx in last 3 months, CKD, lung or cardiac disease ?
Respiratory fluoroquinolone (levo/moxi) po, or macrolide + either amoxicillin or amoxicillin/clav.
Do not use erythromycin monotherapy. |
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Term
| Initial therapy for: PSI > 91, Ward |
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Definition
Initial therapy for: PSI > 91, Ward
Respiratory fluoroquinolone (levo/moxi)
or
Macrolide + B-lactam (penicillins, cephalosporins, monobactams, carbapenem) |
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Term
| Initial therapy for: PSI > 91, ICU |
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Definition
Initial therapy for: PSI > 91, ICU
Beta lactams ((penicillins, cephalosporins, monobactams, carbapenem)
AND
Either respiratory fluoroquinolone, OR Macrolide |
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Term
| Initial treatment for ICU pseudomonas aeruginosa suspected? |
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Definition
Initial treatment for ICU pseudomonas aeruginosa suspected?
Antipseudomonal B-lactam (cefepime, imipenem, meropenam, pip/tazo)
PLUS:
cipro
OR
Aminoglycoside + macrolide
OR
Aminoglycoside + cipro |
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Term
| Abx therapy for CAP, pathogen: Strep Pneumoniae non-resistant resistant Alternatives for penicillin allergy? |
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Definition
Abx therapy for CAP, pathogen: Strep Pneumoniae
Penicillin non-resistant: Penicillin G, amoxicillin
Alternative for penicillin non-resistant: macrolide or respiratory fluoroquinolone or doxycycline, or clindamycin, cephalosporins
Penicillin Resistant: cefotaxime, ceftriaxone, or respiratory fluoroquinolone
Alternative for penicillin resistant: Vanco or linezolid or HD amoxicillin |
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Term
Abx therapy for CAP, pathogen: H. influenzae
if non beta-lactamase ? |
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Definition
Abx therapy for CAP, pathogen: H. influenzae
2nd OR 3rd gen cephalosporin OR Amoxicillin/clav, fluoroquinolones, doxycycline, azithro, clarithro,
Non-beta lactamase - amoxicillin monotherapy |
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Term
Abx therapy for CAP, pathogen: Staph. Aureus
Resistant
Non-resistant |
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Definition
Abx therapy for CAP, pathogen: Staph. Aureus.
non-resistant - cloxacillin, cefazolin, clindamycin
resistant - vancomycin, linezolid, tigecycline |
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Term
| Abx therapy for CAP, pathogen: Legionella |
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Definition
Abx therapy for CAP, pathogen: Legionella
Fluoroquinolones or Azithromycin |
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Term
| Abx therapy for CAP, pathogen: Mycoplasma pneumoniae or Chlamydophylia pneuomoniae |
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Definition
Abx therapy for CAP, pathogen: Mycoplasma pneumoniae or Chlamydophylia pneuomoniae:
Macrolides, tetracyclines |
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Term
| Abx therapy for CAP, pathogen: Coxiella burnetii |
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Definition
Abx therapy for CAP, pathogen: Coxiella burnetii:
Doxycycline, FQs, Macrolides |
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Term
| Abx therapy for CAP, pathogen: aerobic gram(-) bacilli: |
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Definition
Abx therapy for CAP, pathogen: aerobic gram(-) bacilli:
3rd gen cephalosporin, carbapenem |
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Term
| Abx therapy for CAP, pathogen: Pseudomonas Aeruginosa |
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Definition
Abx therapy for CAP, pathogen: Pseudomonas Aeruginosa
Beta-lactam +
Cipro OR aminoglycoside Or BOTH! |
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Term
| When should a PSV booster be used? How should re-immunization be carried out (specific to ages) |
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Definition
PSV - use in high risk patients such as CKD or immunosuppressed.
reimmunize after 5 years in those >10 when taken first shot, and after 3 years in those <10 when taken first shot. |
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Term
Healthy pregnant woman with CAP, what Abx?
Severe CAP?
High macrolide or Beta-lactam resistant settings?
Pseudomonas Aerginosa ? |
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Definition
Abx of choice - macrolides
Severe CAP - Beta-lactam & macrolide
resistant settings - FQs
P. Aeruginosa - antipseudomonal Beta-lactam (imipenem, meropenem, Pip/tazo, cefepime) + azithro + aminoglycoside |
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