Pneumonia
Wonder Me!
PNEUMONIA
CAP etiology: Strep. Pneumoniae most common, bacteria/virus
CAP: @ onset of dx, pt resides w/in commmunity, NOT in nursing home/other care facility, no recent (<2wks) hospitalization
CXR, No dx tests, Pretreatment blood culture, sputum. Severe: urinary antigen for Legionella & Strep.
Outpt Tx:
Empirical therapy:
A - Healthy pt (<60 y/o w/ no comorbidies):  (Mac)
  • Macrolide (azithromycin, clarithromycin, erythromycin)
  • Doxycycline
B - Sick pt (>65 y/o, ca., heart/lung/liver/renal dz, ETOH, asplenia,immunosuppressed, ABX use w/in 3 mo.. ) (Queen)
  • Resp. fluoroquinolone (moxifloxacin, gemifloxacin or levofloxacin) LeGeM
  • Beta-lactam* plus a macrolide/doxycycline.
*Beta-lactam: High-dose amoxicillin, amoxicillin-clavunate, OR ceftriaxone, cefpodoxime, cefuroxime

Target therapy:


By Qt 

S.Pneumoniae:
  • Non-resistant: macrolides, tetracyclines including doxycycline,select cephalosporins, standard dose amoxicillin
  • DRSP (Drug-resitant Strep. Pneumoniea): respiratory fluoroquinolones, high-dose amoxicillin, telithromycin

H. influenza: beta-lactamase production (agents active against G- & stable in presence of or active aginast beta-lactamase).. Common pathogen for tobacco-related disease
  • Tx: macrolides,tetracyclines including doxycycline, respiratory fluoroquinolones, cephalosporins, amoxicillin-clavulanate

Legionella spp: transmitted thru inhaling mist or aspirating liquid from contaminated water. No person-to-person spread. Severe PNA with diarrhea
  • Tx: macrolides, tetracyclines including doxycycline, respiratory fluoroquinolones
  • Ineffective: beta-lactams

C. pneumoniae, M. Pneumoniae (walking, tiny bacteria pneumonia): transmitted by cough in closed communities, e.g. correctional facilities, dorm, LTC.
  • Tx: macrolides,,tetracyclines including doxycyclines, respiratory fluoroquinolones
  • Ineffective: beta-lactams (these bacterias don’t have a huge cell wall) 

~By Qt

 http://www.cram.com/flashcards/np-review-respiratory-4774248
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