Pharmacotherapeutics IV - Pneumonia
Terms
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- Etiologies of CAP
-
-chlamydia (atypical)
-h. influenzae (-)
-legionella (atypical)
-moraxella (-)
-mycoplasma pneumoniae (atypcial)
-staph aureus (+)
-strep pneumoniae (+) - Upper lobe involvement indicates:
- aspiration, TB
- Lower lobe involvement indicates:
- most bacterial pneumonias
- Who should sputum staining and culture be performed for?
- all patients admitted to the hospital
- Empiric outpatient tx of CAP
-
-macrolide OR
-doxycycline OR
-FQ - Inpatient, general medical ward empiric treatment of CAP
-
-ES cephalosporin + macrolide
-BL/BLI + macrolide
-BL/BLI + FQ - Inpatient, ICU empiric treatment of CAP
-
-ES ceph +FQ
-ES ceph + macrolide
-BL/BLI + FQ
-BL/BLI + macrolide - Etiology of Nosocomial pneumonia
-
CAP +
-Gram - bacilli
-Anaerobes
-Stenotrophoomonas maltophilia - Empiric antibiotic therapy for HAP in patients with no known risk factors for MDR pathogens, early onset, and any disease severity
-
-ceftriaxone OR
-Levo, moxi, ciprofloxacin OR
-ampicillin/sulbactam OR
-ertapenam - Empiric antibiotic therapy for HAP in patients with late-onset disease or risk factors for MDR pathogens and all disease severity
-
Antipseudomonal ceph (cefepime, ceftazidime) OR
Antipseudomonal ceph (imipenam, meropenam) OR
BL/BLI (pipercillin/tazobactam)
**PLUS**
Antipseudomonal FQ (cipro, levo) OR
aminoglycoside (amikacin, gentamicin, tobramycin)
**PLUS**
Linezolid OR vancomycin - Duration of therapy for HAP
- 7-14 days; 14-21 days for severe infections caused by organisms such as pseduomonas
- Non-pharmacological therapy
-
-O2, hydration, nutrition
-bronchodilators: albuterol-improve oxygenation in bronchospastic pts; ipratropium-dry excessive respiratory secretions)
-chest PT, smoking cessation - Treatment of drug-resistant S. pneumoniae therapy
-
-Telithromycin and newer generation FQs
-Vancomycin only for high-level drug-resistant S. pneumoniae infection
(>2mcg/ml) - Alcoholism
-
-strep pneumoniae
-anaerobes - Poor dental hygiene
- anaerobes
- Large-volume aspiration
- anaerobes
- Airway obstruction
-
-anaerobes
-s. pneumoniae
-h. influenzae
-s. aureus - Structural disease of lung (cystic fibrosis)
-
-pseudomonas
-s.aureus