LRTI Flashcards
CAP
out patient
Healthy no risk
Amoxicillin 1g TID [strongest evidence]
Doxycycline 100mg BID
Macrolide (pneumococcal resistance <25%)
▪ Azithromycin 500mg once then 250mg daily
▪ Clarithromycin 500mg BID (1000mg ER daily)
CAP
Outpatient
Comorbidities
Amoxicillin/clavulanate OR cephalosporin (cefpodoxime/cefuroxime)
PLUS
Macrolide (azithromycin/clarithromycin) OR doxycycline
Respiratory fluoroquinolone (levofloxacin/moxifloxacin) ALONE
If recent exposure to one class of antibiotics recommended above, select an antibiotic from a different class
CAP
symptoms begin in an outpatient setting or within 48 hrs of hospital admission of hospital
HAP
at admissions that occurs >= 48 hrs after admission
VAP
occurs > 48 hrs after endotracheal incubation
clinical presentation of pneumonia
cough+/- sputum
fever, sweats, chills,
pleuritic chest pain
Gold standard diagnosis for pneumonia
chest x ray
Causative pathogens of CAP
Streptococcus pneumoniae
H. influenzae
Mycoplasma pneumoniae
Staphylococcus aureus
Legionella species
Chlamydia pneumoniae
Moraxella catarrhalis
Validated clinical prediction rule preferred
pneumonia severity index (PSI)
PSI
<90
out patient
Risk class I, II, II
PSI
>90
inpatient
Risk class IV,V
Severe CAP
1 major criteria
3 minor criteria
urinary antigen testing
severe CAP
Pneumococcal
legionella
CAP
non severe
b- lactam + macrolide
or respiratory fluroquinolone
