8/28/06 Pneumonia
Terms
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- Empiric treatment of CAP outpatient and uncomplicated
-
a)azithromycin 500mg PO qd x3d or 2g PO x1
b)doxy 100mg PO BID x7-10d - Empiric treatment of CAP in adults outpatient and comorbidity (diabetes, COPD, CHF, etc.)
-
Fluoroquinolone or ketolide
a)Telithromcyin 800mg qd PO x7-10d
b)levofloxacin 750mg/d PO x5d - Empiric treatment of CAP in adults hospitalized patient
-
1)Levo 750mg IV/PO q24hr x7-10d
2)Ceftriaxone 1gm IV q24hr AND azithro 500mg IV/PO qd x3days - Empiric therapy for HAP
-
1)imipenem 500mg IV q6hr (if suspected legionella/ bioterrorism-AND FQ)
2)Zosyn 4.5gm IV q6hr OR cefepime AND tobramycin (ADD FQ if legionella/bioterror) -
Duration of therapy for
a)CAP
b)HAP -
a)7-14days (14 w/ anaerobes, atypicals)
b)7-14 (14-21 w/ pseudomonas) - Etiology of CAP
-
a)strep pneumo
b)mora catt
c)haem influ
d)mycoplasma
e)chlamydia species
f)legionella
g)staph aureus - Etiology of HAP
-
a)strep pneumo
b)haem influ
c)staph aureus
d)gram - bacilli (e.coli, kleb, pseudo, enterobacter, prot, serr, acinetobacter)
e)stenotrophomonas
f)anaerobes - What constitutes a MDR causing HAP?
-
1)antibiotic use in last 90days
2)current hospital stay >5days
3)immunosupp therapy/disease
4)area of resistance
5)risk factors for HAP
a)NH
b)chronic dial w/in 30days
c)home wound care
d)>2days in hospital in last 90days - Alcoholism
-
a)strep pneumo
b)anaerobes - COPD/smoking
-
a)strep pneumo
b)haemo influ
c)morax catt
d)legionella - poor dental hygience
- anaerobes
- HIV infection (early)
-
a)strep pneumo
b)haem influ
c)mycobacterium tb - suspected large volume aspiration
- anaerobes
- structural disease of lung (cystic fibrosis)
-
a)pseudomonas
b)burkholderia
c)staph aureus - injection drug use
-
a)strep pneumo
b)staph aureus
c)anaerobes
d)mycobacterium tb - airway obstruction
-
a)strep pneumo
b)staph aureus
c)haem influ
d)anaerobes - pneumococcus
- penicillin
- legionella
- azithromycin
- mycoplasma
- doxycycline
- haem influ
- cefuroxime
- chlamydia pneum
- doxycycline
- moraxella catar
- cefuroxime
- mouth flora
- unasyn or clindamycin
- psudomonas aeruginosa
- piper AND gent
- enterobacter
- piper +/- gent
- serratia
- piperacillin
- klebsiella
- piperacillin
- acinetobacter
- imipenem
- staph aureus
- oxacillin/nafcillin
- Aspiration pneumonia
- clindamycin 600mg IV q8hr + fluoroquinolone
- Influenza +/- superinfection
- ceftriaxone or cefotaxime +/-oseltamivir 75 mg bid x 5 d
- HAP empiric therapy low risk of MDR (4)
-
a)ceftriaxone 2 gm/d IV
b)levofloxacin 750 mg
c)Unasyn 2gm IV q6h
d)ertapenem 1 gm IV qd - HAP empiric therapy high risk of MDR
-
1)beta-lactam (antipseudomonal)AND
2) fluoroquinolone or aminoglycoside AND
3)vancomycin or linezolid
1)zosyn, imipenem, cefepime, ceftazidime
2)levo,cipro,gent,tobra, amikacin
3)vanco 15mg/kg IV q12hr or linezolid 600mg IV q12hr
Follow-up at 48-72h (clinically improved): cx negative - consider stopping abx; if cx positive - de-escalate, treat for 7-8d.
Follow-up at 48-72h (clinically unimproved): cx negative - look for alternative causes; cx positive - adjust abx.