Chapter 42 pneumonia

Question 1

Common adult pathogens

Answer 1

• s.pneumoniae
• pt with underlying lung dz-haemophilus influenza, morganella catarrhalis
• staph aureus: co-pathogen with influenza
• mycoplasma pneumoniae
• viral pneumonia

Question 2

CAP levels

Answer 2

I: previously healthy, no risk factors for drug resistance to s.pneumonia
II: patients with risk factors
III: not admitted to ICU
IV: admitted to ICU

Question 3

CAP TX for healthy adult

Answer 3

• macrolides (level I)-azithromycin, clarithromycin, erythromycin
• doxycycline if allergic
• tx for at least 5 days

Question 4

Pathiphysiology

Answer 4

• organism invades lung parenchyma and host defenses depressed
• bacterial pneumonia occurs when lung’s primary defenses are altered either by viral infection or immunologic problems

Question 5

CAP tx for level II

Answer 5

• respiratory fluoroquinolones (moxifloxacin, gemifloxacin, levofloxacin)
• beta lactam PLUS macrolide (amoxicillin, amoxicillian/clavulanate, cefpodoxime, cefurosime….)
• doxycycline may be used as substitute for macrolide

Question 6

CAP tx for pt>60 yrs with comorbities

Answer 6

• outpatient option:
• ceftriaxone (Rocephin) 1g daily IV/IM or levofloxin 500 mg IV daily
• switch to oral once pt can tolerate

Question 7

CAP in pregnant women

Answer 7

-macrolide choices: cat B-erythromycin, azithromycin
Cat C: clarithromycin
-if comorbities or recent abx: beta lactam PLUS macrolide

Question 8

pneumonia in children

Answer 8

• 4-6 wks old-possible chlamydia
• 5-adolescence-possible mycoplasma
• most commonly s.pneumonia
• CA-MRSA,and virus

Question 9

pediatric abx choices

Answer 9

5yrs old

- erythromycin 40-50 mg/kg/day-usually loading dose than decrease
- azithromycin 10mg/kg day 1; 5mg/kg day on days 2-5
- clarithromycin 15 mg/kg per day in 2 doses