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PHARMACOLOGY > Bacterial pneumonia > Flashcards

Bacterial pneumonia Flashcards

1
Q

What are the different classifications of pneumonia

A

CAP: community-acquired
pneumonia
* HAP: hospital-acquired
pneumonia
* VAP: ventilator-associated
pneumonia
* Aspiration pneumonia

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2
Q

Predisposing conditions to pneumonia

A

Very young or old age
* Other concomitant disease
* Malnutrition
* HIV infection

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3
Q

Management of pneumonia is guided by:

A

Age
* Co-morbidities
* Severity of pneumonia

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4
Q

Symptoms of pneumonia

A

Fever
* Cough (becomes productive and discoloured)
* Shortness of breath
* Malaise
* Chest pain
* Severe: shock and respiratory failure

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5
Q

How are symptoms different in the frail elderly

A

fever and cough are often absent, new of worsening
confusion, deterioration of functional status or decompensating of
underlying diseases

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6
Q

Signs of pneumonia

A

Fever (≥38⁰C)
* Crackles or crepitations
* Tachypnoea
* Bronchial breath sounds
* Labs: leukocytosis, procalcitonin

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7
Q

Bacteria responsible for CAP (10)

A

S. pneumoniae
S. aureus
Atypicals
(Legionella
pneumoniae,
Mycoplasma
pneumoniae,
Chlamydia
pneumoniae)
H. influenzae

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8
Q

bacteria responsible for HAP

A

Staphylococcus
aureus
G- enterics
(Klebsiella
pneumoniae)
G- nonenterics
(P. aeruginosa,
H. influenzae
M. catarrhalis)

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9
Q

bacteria responsible for VAP

A

S. pneumoniae
S. aureus
Haemophilus
influenzae

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10
Q

bacteria responsible for Aspiration pneumonia

A

B. Melaninogenicus
Fusobacteria
anaerobic streptococci
Polymicrobial infections
with
S. aureus,
S. pneumoniae
gram-negative bacilli

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11
Q

Bacteria causing PJP (OPPORTUNISTIC INFECTION-FUNGAL INFECTION)

A

P. jiroveci
Mycobacterium
M. tuberculosis

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12
Q

G+ BACTERIA CAUSING CAP

A

Gram Positive streptococci
* S. pneumoniae (pneumococcal pneumonia)
Gram Positive staphylococci
* S. aureus

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13
Q

G- bacteria causing CAP

A

Gram Negative found in GI tract (enterics)

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14
Q

Atypical pneumonia-causing bacteria

A

Legionella, Mycoplasma & Chlamydia (atypical pneumonia)

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15
Q

In COPD pts, what usually causes pneumonia

A
  • H. influenzae (COPD)
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16
Q

Explain the CURB scoring for assessing severity of CAP

A
  • Confusion
  • Urea > 7mmol/L
  • Respiratory rate > 30 breaths/min
  • Low Blood Pressure (SBP <90/DBP<60)
  • Age > 65 yr
    CRB-65
  • CURB-65 with no Urea
17
Q

what are the treatment considerations for CAP

A

Setting
* Age (65 years)
* Antibiotic use in past 90 days
* Drug intolerance/allergy
* Comorbidities
* Alcoholism / chronic liver disease
* Cardiovascular disease / cardiac failure
* Chronic kidney disease
* COPD
* Diabetes mellitus
* HIV

18
Q

If a patient scores </= 1, what tx setting would you use

A

Home

19
Q

If a patient scores 2, what tx setting would you use

A

hospital

20
Q

If a patient scores >/=3, what tx setting would you use

A

Hospital admission to ICU

21
Q

drug tx for outpatients if <65 and no antibiotic tx in the past 90 days

A

Amoxicillin PO

22
Q

drug tx for outpatients if >65 and antibiotic tx in the past 90 days

give alternatives as well

A

co-amoxiclav or 2nd gen cephalosporin PO

Moxifloxacin or
levofloxacin

23
Q

drug tx for inpatients if <65 and no antibiotic tx in the past 90 days

A

Ampicillin PO/IV

24
Q

drug tx for inpatients if >65 and antibiotic tx in the past 90 days

GIVE ALTERNATIVE

A

Co-amoxiclav
OR cefuroxime
OR 3rd gen cephalosporin

Moxifloxacin, levofloxacin

25
Q

drug tx for ICU pts if <65 and no antibiotic tx in the past 90 days

A

Co-amoxiclav
OR cefuroxime
OR 3rd gen cephalosporin
PLUS macrolide/azalide

IV

26
Q

drug tx forICU patients if >65 and antibiotic tx in the past 90 days

GIVE ALTERNATIVES

A

Co-amoxiclav
OR cefuroxime
OR 3
rd
gen cephalosporin
PLUS macrolide/azalide

Moxifloxacin or
levofloxacin
PLUS cefuroxime
OR 3
rd
gen cephalosporin

27
Q

CAP adjuvant tx used to increase outcomes of SEVER CAP requiring ICU admission

A

Addition of macrolide (azithromycin)
* Better outcomes in severe CAP requiring ICU admission

Systemic corticosteroids
* Severe CAP requiring ICU admission
* Methylprednisone 0.5 mg/kg/12 h or equivalent
* Not if influenza or TB is likely, or history of GI bleeding in past 90 days

28
Q

How do you monitor CAP tx?

A

Review culture results and sensitivity
Decrease
* Temperature ( over 8-24 hours)
* WBC
* s/sx of infection
Increased appetite- functional GI tract
Improved Chest X-ray

29
Q

Bacterial causes of CAP in children

A

Non-typical H. influenza & S. aureus leading bacterial causes of severe pneumonia in children

30
Q

Viral causes of CAP in children

A

Respiratory viruses
* Leading cause of pneumonia in young children Respiratory syncytial
virus (RSV) 18 to 31% of pneumonia episodes

31
Q

opportunistic organisms causing CAP in children

A

Opportunistic organisms
* PJP & cytomegalovirus (CMV)
* Atypicals

32
Q

how to identify pneumonia severity in children

A

Rapid Breathing
* Infant birth – 2 mo > 60 breaths/min
* Infant 2 mo– 1 yr> 50 breaths/min
* Children 1-5 yr > 40 breaths/min

33
Q

danger signs when a peads pt has severe pneumonia

A

Danger Signs
* O2 sat < 90% room air
* Cyanosis
* Inability to drink
* < 2 mo
* Impaired consciousness
* Grunting

34
Q

Management and Tx of sever pneumonia in children

A

Ensure adequate hydration
Continue feeding
Penicillin Allergy: Macrolide - Azithromycin, oral
Ceftriaxone

35
Q

cautions for ceftriaxone usage in children

A

Ceftriaxone use in neonates
* ONLY used in seriously ill neonates, even if jaundiced
* DONOT administer if Ca containing IV infusion being given (< 28 days
of age)
* After 28 days of age, may be given sequentiall

PHARMACOLOGY (20 decks)

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