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Respiratory II, Test 2 > Antiobiotics > Flashcards

Antiobiotics Flashcards

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1
Q

which drugs inhibit cell wall synth?

A

Vancomycin, Bacitracin, Penicillins, Cephalosporins, carbapenems

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2
Q

Ampicillin

A

Aminopencillin

extended spectrum, often administered with B-lactamase inhibitor

Gram +: streptococcus and staphylococcus (not MRSA)
Gram -: H. influenza, E. Coli, Proteus miribalis
Randoms: Listeria monocytogenes

Use: upper resp. tract infections (of S. pyogenes, S. pneumoniae, H. influenzae), sinusitis, otitis media, enterococcal infections

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3
Q

Amoxicillin

A

Aminopenicillin - just PO

extended spectrum, often administered with B-lactamase inhibitor

Gram +: streptococcus and staphylococcus (not MRSA)
Gram -: H. influenza, E. Coli, Proteus miribalis
Randoms: Listeria monocytogenes

Use: upper resp. tract infections (of S. pyogenes, S. pneumoniae, H. influenzae), sinusitis, otitis media, enterococcal infections

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4
Q

Piperacillin

A

Anti-Psudeomonal penicilin

Extended spectrum:
Gram pos: streptococcus and staphylococcus (not MRSA)

Gram negs: H. influenza, E. Coli, Proteus miribalis

Randoms: Listeria monocytogenes

And Extended to more serious gram negatives:
- to Pseudomonas aeruginosa, Enterobacter, and Proteus spp

Therapeutic use: serious gram-negative infections, hospital acquired pneumonia (HAP), immunocompromised patients, bacteremia, burn infections, UTI
.

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5
Q

Cefriaxone

A

third gen. cephalosporin

Less active against gram positive, but more active against gram negatives.
** active against Enterobacteriaceae (i.e. Klebsiella pneumonia, proteus mirabalis, providencia, serratia) and Haemophilus influenza

Therapeutic use:
DOC for for serious gram-negative infections (Klebsiella, Enterobacter, Proteus, Providencia, Serratia, Haemophilus),
- Ceftriaxone DOC for all forms of gonorrhea and severe Lyme’s disease, meningitis

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6
Q

Ceftazidime

A

third gen. cephalosporin

Less active against gram positive, but more active against gram negatives.

    • active against Enterobacteriaceae (i.e. Klebsiella pneumonia, proteus mirabalis, providencia, serratia) and Haemophilus influenza
  • ** ACTIVE AGAINST PSEUDOMONAS **

Use:
DOC for for serious gram-negative infections (Klebsiella, Enterobacter, Proteus, Providencia, Serratia, Haemophilus)
- Ceftazidime covers Pseudomonas

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7
Q

Cefepime

A

Fourth generation Cephalosporin

Spectrum: extends beyond third-generation (some gram +, enterobacteria gram negs), useful in serious infections in HOSPITALIZED PATIENTS. Effective against Pseudomonas

Therapeutic use: empirical treatment of nosocomial infections (infections aqd in hospital)

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8
Q

meropenem

A

carbapenem

  • Very broad spectrum

Covers: aerobic and anaerobic, gram positives, Enterobacteriaceae, Pseudomonas, Acinetobacter

Therapeutic use: UTI, lower respiratory tract infection (LRTI), intra-abdominal, gynecological, SSTI, bone and joint infections – very broad spectrum, should be used VERY sparingly, only In very serious infections!!!

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9
Q

Ertapenem

A

carbapenem

  • Very broad spectrum

Covers: aerobic and anaerobic, gram positives, Enterobacteriaceae, Pseudomonas, Acinetobacter

Therapeutic use: UTI, lower respiratory tract infection (LRTI), intra-abdominal, gynecological, SSTI, bone and joint infections – very broad spectrum, should be used VERY sparingly, only In very serious infections!!!

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10
Q

ampicillin-sublactam

A

B-lactamase inhibitor

MOA: prevent destruction of B-lactam antibiotics

S. Serratia spp
P. Pseudomonas aeruginosa
I. Indole + (Acinetobacter, Morganella, Proteus [not mirabilis])
C. Citrobacter spp
E. Enterobacter cloacae
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11
Q

amoxicillin-clavulanic acid

A

B-lactamase inhibitor

MOA: prevent destruction of B-lactam antibiotics

S. Serratia spp
P. Pseudomonas aeruginosa
I. Indole + (Acinetobacter, Morganella, Proteus [not mirabilis])
C. Citrobacter spp
E. Enterobacter cloacae
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12
Q

Piperacillin-tazobactam

A

B-lactamase inhibitor

MOA: prevent destruction of B-lactam antibiotics

S. Serratia spp
P. Pseudomonas aeruginosa
I. Indole + (Acinetobacter, Morganella, Proteus [not mirabilis])
C. Citrobacter spp
E. Enterobacter cloacae
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13
Q

Vancomycin

A

glycopeptide

MOA: inhibits cell wall synthesis binding with high affinity to D-Ala-D-Ala terminal of cell wall precursor units

Spectrum: broad gram-positive coverage
S. aureus (including MRSA), S. epidermidis (including MRSE), Streptococci, Bacillus, Corynebacterium spp, Actinomyces, Clostridium

Therapeutic use: osteomyelitis, endocarditis, MRSA, Streptococcus, enterococci, CNS infections, bacteremia, orally for Clostridium difficile (only oral indication for Vanc)

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14
Q

ciproflaxacin

A

fluoroquinolone

MOA: targets bacterial DNA gyrase & topoisomerase IV. Prevents relaxation of positive supercoils

Spectrum: E. coli, Salmonella, Shigella, Enterobacter, Campylobacter, Neisseria, Pseudomonas aeruginosa, S. aureus (not MRSA), limited coverage of Streptococcus spp.

Therapeutic use: UTI, prostatitis, STI (chlamydia, Neisseria gonorrhoeae), traveler’s diarrhea, shigellosis, bone, joint, SSTI infections, diabetic foot infections

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15
Q

Levoflaxacin

A

Fluoroquinolone

MOA: targets bacterial DNA gyrase & topoisomerase IV. Prevents relaxation of positive supercoils

Spectrum: E. coli, Salmonella, Shigella, Enterobacter, Campylobacter, Neisseria, Pseudomonas aeruginosa, S. aureus (not MRSA), limited coverage of Streptococcus spp.

Therapeutic use: UTI, prostatitis, STI (chlamydia, Neisseria gonorrhoeae), traveler’s diarrhea, shigellosis, bone, joint, SSTI infections, diabetic foot infections

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16
Q

Moxifloxacin

A

Fluoroquinolone

MOA: targets bacterial DNA gyrase & topoisomerase IV. Prevents relaxation of positive supercoils

Spectrum: E. coli, Salmonella, Shigella, Enterobacter, Campylobacter, Neisseria, Pseudomonas aeruginosa, S. aureus (not MRSA), limited coverage of Streptococcus spp.

** this one is metabolized by the liver, so it does not need to be dose adjusted for those with renal failure!

Therapeutic use: UTI, prostatitis, STI (chlamydia, Neisseria gonorrhoeae), traveler’s diarrhea, shigellosis, bone, joint, SSTI infections, diabetic foot infections

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17
Q

Gentamicin

A

Aminoglycoside

MOA: binds 30S

Spectrum: aerobic gram-negative bacteria, limited action against gram-positive, synergistic bactericidal effects in gram-positive with cell wall active agent (like Beta lactam or Vanc)

Therapeutic use: UTI (not uncomplicated), used if resistance to other agents, seriously ill patients, pneumonia (infective against S. pneumoniae and anaerobes), HAP, peritonitis, synergy in bacterial endocarditis, tobramycin inhalation in CF

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18
Q

Doxycycline

A

tetracycline/glycylcylclines

Spectrum: wide range of aerobic/anaerobic gram + and gram - (as well as Rickettsia, Coxiella burnetii, Mycoplasma pneumoniae, Chlamydia spp, Legionella, atypical mycobacterium, Plasmodium, Borrelia burgdorferi (Lyme’s disease), Treponema pallidum (syphilis)

** Pseudomonas not covered ***

Therapeutic use: CAP, atypical CAP coverage, community acquired SSTIs, community acquired MRSA, acne, Rickettsial infections (Rocky Mountain Spotted Fever), Q fever, anthrax

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19
Q

Azithromycin

A

macrolide/ketolide

MOA: inhibits translocation of 50s subunit

Use: : respiratory tract infections (due to coverage of S. pneumoniae, H. influenzae, and atypicals: Mycoplasma, Chalmydophilia, Legionella), alternative for otitis media, sinusitis, bronchitis, and SSTIs. Pertussis, gastroenteritis, H. pylori, Mycobacterial infections

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20
Q

Clindamycin

A

Lincosamide

MOA: binds 50S subunit

Spectrum: pneumococci, S. pyogenes, viridans Streptococci, MSSA, anaerobes (B. fragilis)
(all gram negs are resistant)

Use:
SSTIs, necrotizing SSTIs, lung abscesses, anaerobic lung and pleural space infections, topically for acne vulgaris

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21
Q

Linezolid

A

oxazalidinone:

MOA: inhibits synth binding P site of 50S

Spectrum: : gram-positive Staphylococcus (MSSA, MRSA, VRSA), Streptococcus (penicillin resistant S. pneumoniae), enterococci (VRE), gram-positive anaerobic cocci, gram-positive rods (Corynebacterium, L. monocytogenes)

Use: VRE faecium (SSTI, UTI, bacteremia), nosocomial pneumonia caused by MSSA and MRSA, CAP, complicated/uncomplicated SSTI infections

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22
Q

Oseltamivir

A

Antiviral- “Tamiflu”

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23
Q

Flucanazole

A

Antifungal

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24
Q

Itraconazole

A

Antifungal

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25
Voriconazole
Antifungal
26
Empiric Therapy
Provide therapy to a symptomatic patient without identification of infecting organism Example: initiating antimicrobials for community-acquired pneumonia (CAP) based on knowledge of most likely infecting pathogen
27
Extended-spectrum:
active against gram-positive bacteria but also against significant number of gram-negative bacteria
28
Broad-spectrum:
: act on a wide variety of bacterial species, including both gram-positive and gram-negative
29
MOA of Beta- lactams
i.e. penicillins B-lactams are structural analogs of D-Ala-D-Ala; they covalently bind penicillin-binding proteins (PBPs), inhibiting the last transpeptidation step in cell wall synthesis Resistance: through drug destruction and inactivation of B-lactamases
30
Penicillin
A type of beta-lactam | - effective against gram-positive cocci: narrow spectrum against streptococcus pneumoniae and meningitis
31
Penicillin
Beta-lactam Spectrum: highly effective against gram-positive cocci (GPC) but easily hydrolyzed by penicillinase Therapeutic use: narrow-spectrum, Streptococcus pneumoniae pneumonia and meningitis.
32
AE's of penicillins?
- Allergic reactions (0.7-10%) - Anaphylaxis (0.004-0.04%) – this is rare, and completely CI - Interstitial nephritis (rare) - Nausea, vomiting, mild to severe diarrhea - Pseudomembranous colitis
33
AE'S of cephalosporins?
1% risk of cross-reactivity to penicillins Diarrhea Intolerance to alcohol (disulfram-like reaction due to MTT group of cefotetan)
34
AE's of Carbapenems
Adverse effects: Nausea/vomiting (1-20%) Seizures (1.5%) Hypersensitivity
35
AE's of glycopeptides?
i.e. vancomycin Macular skin rash, chills, fever, rash Red-man syndrome (histamine release): extreme flushing, tachycardia, hypotension Ototoxicity, nephrotoxicity (33% with initial tr > 20 mcg/mL)
36
AE's of fluoroquinolones?
-oxacin GI 3-17% (mild nausea, vomiting, abdominal discomfort) CNS 0.9-11% (mild headache, dizziness, delirium, rare hallucinations) Rash, photosensitivity, Achilles tendon rupture (CI in children) DON'T USE IN CHILDREN UNLESS TOTALLY NECESSARY!
37
AE's of aminoglycosides?
ex. gentamicin Ototoxicity (may be as high as 25%) Nephrotoxicity (8-26%) Neuromuscular block and apnea
38
AE's of tetracyclines?
``` GI (epigastric burning, abdominal discomfort, nausea, vomiting, diarrhea) Superinfections of C. difficile Photosensitivity Teeth discoloration Thrombophlebitis ```
39
AE's of Macrolides/ketolides
Azithromycin - Arrythmia, QT prolongation - Hepatotoxicity: CYP3A4 inhibition – prolongs effects of digoxin, warfarin….
40
AE's of lincosamides?
clindamycin ``` GI diarrhea (2-20%) Pseudomembranous colitis (0.01-10%) Due to C. difficile Skin rashes (10%) Reversible increase in aminotransferase activity May potentiate neuromuscular blockade ```
41
AE's of Oxazolidinones
Myelosuppression [anemia, leukopenia, pancytopenia, thrombocytopenia (2.4%)] Headache Rash
42
empiric tx previously healthy pt?
Azithromycin or Doxycycline
43
empiric tx of outpatients at risk for DRSP?
fluoroquinolone or Beta lactam (ceftriaxone or ampicillin) + Azithromyocin
44
empiric tx of non ICU inpatient?
levofloxacin/moxifloxacin or Beta lactam (ceftriaxone) + azithromyocin
45
empiric tx of ICU patients?
Beta lactam (ceftraixone or ampicillin) + azithromyocin or Beta lactam (ceftriaxone) + levofloxacin/moxifloxacin NOTE: use aztreonam in case of penicillin allergy (anaphylaxis) for the Beta Lactam
46
tx of pseudomonas aeruginosa?
anti-pseudomonal B lactam (piperacillin-tazobactam, cefepime, meropenem) + cipro/levofloxacin OR B lactam + gentamicin AND azithromycin OR B lactam + gentamicin and anti-pseudomonal fluoroquinolone
47
tx of MRSA?
Vancomycin IV or linezolid
48
tx of MRSA/necrotizing pneumonia?
clindamyacin or linezolid
49
what is minimum amount of time to receive Ab?
5 days, though most take it for 7 - 10 days
50
how long must you tx pseudomonas
at least 8 day course (though 15 is shown to be more effective)
51
aerobic gram negatives seen in HAP/VAP/HCAP?
P. aeruginosa E. Coli K. pneumoniae Acinetobacter spp
52
gram positive cocci seen in HAP/VAP?
MRSA - more common in DM, head trauma, those in ICU
53
oronpharyngeal bugs seen in HAP/VAP?
Viridans Coagulase-negative staph Neisseria corynebacterium
54
Emperic therapy to early onset pneumonia?
``` possible pathogens: S. pneumoniae H. influenza MSSA gram negs: E. coli, K. pneumoniae, Enterobacter, Proteus, Serratia ``` Tx: Ceftiaxone OR FQ OR ampicillin OR ertapenem
55
Late onset pneumonia or known risk factors for MDR pathogens?
potential pathogens: P. aeruginosa, K. pneumoniae, Actinobacter, MRSA ``` Tx: Antipseudomonal cephalosporin (Cefepime, ceftazidime) OR antipsuedomonal carbapenem (meropenem) OR B-lactam (piperacillin-tazobactam) ``` + Antipsuedomonal FQ (cipro/levofloxacin) OR aminoglycoside (gentamicin) + Linezolid or Vanc Treat for 7 days
56
tx for strep pneumoniae?
penicillin G or amoxicillin
57
tx fo Penicillin resistant strep pneumoniae?
ceftriaxone
58
tx for non beta lactamase producing H. influenzae?
amoxicillin
59
tx. for beta lactamase producing H. influenzae?
second or third generation cephalosporin or amoxicillin
60
tx for Mycoplasma pneumoniae?
azithromyocin or doxycycline
61
tx for Chlamydophila pneumoniae?
azithromyocin or doxycycline
62
tx. for legionella species?
FQ (cipro/levo/moxifloxacin) or azithromycin
63
tx for chlamydophila psittaci
tetracycline (i.e. doxycycline)
64
tx for enterobacteriaceae (klebsiella, E. Coli, Enterobacter, Proteus)
3rd or fourth generation cephalosporin (ceftriaxone, ceftiazidime, cefepime) or carbapenem (meropenem, ertapenem)
65
tx for pseudomonas aeruginosa?
antipseudomonal B lactam (pipercillin) + cipro/levofloxacin or gentamicin
66
tx for anaerobic aspiration?
i.e. bacteriodes, fusobacterium, peptostreptococcus = Beta lactam, clindamyacin
67
tx for methicillin susceptible staph aureus?
penicillin
68
tx for MRSA?
Vancomyocin or linezolid
69
tx for bordatella pertussis?
azithromyocin
70
tx for infleunza virus?
oseltamivir or zanamivir (tamiflu)
71
tx for histoplasmosis/blastomycosis?
itraconazole
72
tx for mycobacterium tuberculosis?
Isoniazid + rifampin + ethambutol + pyrazinamide
73
which drugs bind 30S?
aminoglycosides (gentamicin) | Tetracyclines (Doxycycline)
74
56 y/o male presents due to fever, chills, productive cough and confusion. gram stain shows abundant neutrophils and gram + dipplococci?
most common is strep pneumoniae* - need empiric coverage previously healthy patient? recommend azithromycin or doxycycline
75
which drug binds 50S?
macrolides - azithromycin lincosamides - clindamycin oxazolidinones - linezolid
76
binds DNA gyrase preventing relaxation of DNA supercoids?
fluoroquinolones
77
blocs protein synth by inhibiting translocation?
macrolides, clindamycin
78
disrupts cell membrane structure
polmyxins, daptomycin
79
prevents initiation of protein synth
aminoglycosides, linezolid
80
what do you treat resistance strep pneumo with high level resistance to penicillin?
Levofloxacin - high resistance should give an HAP Ab
81
what is mechanism of resistance for strep pneumonia?
alteration of Penicillin binding protein
82
what bacteria would you see if on a cruise or in a hotel room?
legionella
83
risk factors for DRSP?
old age >65, B-lactam use within 3 mos, alcoholism, Immunosuppressive illness, exposure to child at day care
84
Which bug most often uses Beta lactamases as resistance mechanism?
think of as resistance to staph aureus
85
68 y/o female in ED with hx of productive cough and fever, c/o SOB and sharp pains, was tx with ciprofloxacin for UTI 3 weeks prior, has left lower lobe infiltrate which regimin is most appropriate if tx with CAP?
CURB-65: confusion, uremia, respiration, low BP- 65? she has two of these (age and increased RR) --> admit as an inpatient to hospital with ddx of CAP Had been on Cipro in the past - thus tx as you would inpatient non-ICU: ceftriaxone + azithromycin if had Beta lactam allergy: would give respiratory FQ
86
what do you use if allergic to Beta lactams with inpatient in ICU?
for ICU patients who are admitted with previous hx of anaphylaxis to penicillin - have to use a beta lactam + FQ /macrolide - this would be an indication for use of aztreonam USE: aztreonam + FQ/azithromycin
87
which antimicrobials cover atypicals?
azithromycin, doxycyclines- these are major empiric txs | levofloxacin, moxifloxacin
88
which drugs do not need to be dose adjusted if prescribed to patients with poor renal fn?
ceftriaxone - this is the only beta lactam thats eliminated half in urine and half in bile and it is not effected by poor renal fn. moxifloxacin - is the other drug that doesn't have to be dose adjusted for renal impairement
89
76 y/o man, post CABG developed fever with increasing O2 demands, high temp, high WBCs, right lower love infiltrate, sputum shows WBC and gram negative bacilli. ddx? Is still on the ventilator....
ventilator associated pneumonia - think pseudomonas aeruginosa (the gram positives you would think of would be staph aureus and MRSA) tx with piperacillin/tazobactam + gentamicin
90
55 y/o male with 6 hour hx of bloody nose - unable to stop bleeding, has multiple bruises, INR is 5.8 - was recently prescribed Ab for pneumonia..... chart review shows recent mycoplasma pneumonia.... what is ddx?
ddx? macrolide - thinking of Azithromycin reaction with warfarin (this binds the 50S ribosomal subunit)
91
CF patient who is 25 that has had increasing yellow green sputum production, showing sx of CF exacerbation - shows staph and psuedomonas. What would empiric therapy be if she has pseudo and MRSA?
patients who are younger than 16: see staph aureus patients who are over 18: see psuedo aeruginosa tobramycin + piperacillin/tazobactam + vancomycin - want to pick two antipseudomonal agents that are sensitive, plus a drug that tx MRSA
92
8 y/o with CAP. wants to be tx as outpatient. what do you not use?
levofloxacin - achilles rupture, not approved under age 16 doxycycline - teeth discoloration cefotaxime - only given IV use amoxicillin or azithromycin
93
aspiration pneumonia in an 85 y/o - admit for CAP, which beta lactam has anaerobic activity? which drug inhibits protein synth and tx aspiration pneumonia?
1. ampicillin/sublactam - ampicillin and amoxicillin are extended spectrum penicillins (they cover anaerobes when combined with beta-lactamases) 2. Clindamycin
94
47 y/o male with RA is maintained on prednisone for 6 years, has fevers, n/s, anorexia, w/l, raises chickens, most likely ddx is?
histoplasma capsulatum - treat with itraconazole which works by inhibiting ergosterol synthetase
95
voriconazole AE?
visual changes - "see flashing lights" or photophobia/color changes
96
What Respiratory FQ's to use?
Use Ciprofloxacin when suspect P aeruginosa Use levofloaxacin/meoxifloxacin when suspect strep pneumonia, but not pseudomonoas aeruginosa
97
tx for patients at risk for DRSP?
comorbities, age >65 y/o, age <2 y/o, use of antimicrobials in past 3 mos (Beta lactams), alcoholism, immunosuppression, exposure to child at day care use levofloxacin or Beta lactam (amoxicillin) + azithromycin
98
when do you use aztreonam?
when patient has penicillin anaphylaxis but is an inpatient in the ICU (thus will use aztreonam + azithromycin/levofloxacin)
99
resistance mechanisms of gram + vs gram - organisms?
gram positive: strep resistance due to PBP binding resistance (staph sometimes due to B-lactamases) gram negative = due to beta lactamases
100
What maintenance therapy may be initiated that acts as an anti-inflammatory and may decrease the virulence of Pseudomonas aeruginosa?
azithromycin
101
AIDS pt. with difficulty breathing?
pneumocytstis jirovecii = fungi tx: preferred is "Bactrim" trimethoprim/sulfamethoxazole
102
use of penicillinG/penicillin V?
streptococcus and syphilis
103
use of oxacillin/naficillin?
anti-staph Abs
104
use of amoxicillin/ampicillin?
"extended spectrum" - covers gram-positive in addition to a few gram-negative organisms, also covers enterococci and Listeria monocytogenes
105
use of piperacillin?
Bottom-line: serious gram-negative infections (Pseudomonas, Enterobacter, Klebsiella), anaerobes
106
use of ceftriaxone/ceftazidime?
Bottom-line: less active against gram-positives, much more active against Enterobacteriaceae
107
use of cefepime?
Bottom-line: good gram-positive in addition to serious gram-negative infections (Pseudomonas)
108
use of carbapenems?
Bottom-line: very broad spectrum! Aerobic and anaerobic gram-positive and gram-negative bacteria. Ertapenem has inferior activity against Pseudomonas.
109
use of vancomycin?
Bottom-line: no gram-negative or mycobacterium coverage. Broad gram-positive (MRSA, MRSE, enterococci)
110
use of FQ's?
Bottom-line: good gram-negative coverage (ciprofloxacin covers Pseudomonas), MSSA, “respiratory FQ’s” cover Streptococcus spp. (levofloxacin)
111
use of gentamicin?
no anaerobic coverage (requires 02 dependent transport into bacterial cell), broad aerobic gram-negative coverage (tobramycin most active against Pseudomonas)
112
use of minocycline/doxycycline?
Bottom-line: wide aerobic and anaerobic gram-positive and gram-negative activity, MRSA, atypical bacteria, Rickettsia, Coxiella burnetii, syphilis. Gap: Pseudomonas.
113
use of azithromycin?
Bottom-line: aerobic gram-positive cocci and bacilli, atypical organisms, inactive against most gram-negatives (except H. influenzae, N. meningitides, Bordetella pertussis)
114
use of clindamycin?
Bottom-line: gram-positive S. pyogenes, Streptococci, MSSA, CA-MRSA, anaerobes. No aerobic gram-negative coverage.
115
use of linezolid?
Bottom-line: gram-positive Staphylococcus (MSSA, MRSA, VRSA), Streptococcus (DRSP), enterococci (VRE), gram-positive anaerobic cocci, gram-positive rods
116
all drugs that cover pseudomonas?
``` Piperacillin/tazobactam Ceftazidime Cefepime Meropenem Aztreonam Tobramycin Gentamicin Ciprofloxacin ```
117
72 y/o female, presents to ED from nursing home, high temp, high RR, low BP, rales in right lower lobe with right lower lobe infiltrate...what is curb-65 score? what is the treatment for empiric therapy of late onset pnuemonia in this case for HAP?
ddx: HCAP CURB-65: confusion, respiratory, BP, 65 = 4 - admit to ICU confusion, BUN>20, RR>30, BP 90/60, age 65 nasal swab shows +MRSA - suspect pneumonia though need sputum or BAL, and blood cultures ``` tx: ceftazidime/cefepime OR meropenem OR Piperacillin-tazobactam + Ciprofloxacin OR Gentamycin + Vanc/Linezolid ```

Respiratory II, Test 2 (9 decks)

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