Management of LRTIs Flashcards
(60 cards)
What are the most common pathogens in community-acquired pneumonia (CAP)?
Streptococcus pneumoniae, Haemophilus influenzae, atypicals like Mycoplasma, Chlamydophila, Legionella
What are the most common pathogens in hospital-acquired pneumonia (HAP)?
MRSA, Pseudomonas aeruginosa, Enterobacterales (e.g., Klebsiella, E. coli), Acinetobacter
What risk factors support MRSA coverage in CAP or HAP?
Prior MRSA colonization/infection, recent IV antibiotics, severe illness, positive nasal PCR
What risk factors support Pseudomonas coverage in CAP or HAP?
Prior Pseudomonas infection, recent IV antibiotics, structural lung disease
What is the typical empiric therapy for outpatient CAP without comorbidities?
Amoxicillin, doxycycline, or macrolide (if resistance <25%)
What is the empiric therapy for inpatient non-ICU CAP with comorbidities?
Beta-lactam (e.g., ceftriaxone) + macrolide or a respiratory fluoroquinolone
What is the preferred empiric regimen for HAP/VAP with MRSA & Pseudomonas risk?
Vancomycin or linezolid + antipseudomonal beta-lactam (e.g., cefepime, piperacillin-tazobactam)
What is the standard duration of therapy for CAP and HAP?
CAP: 5 days if stable. HAP/VAP: 7 days depending on severity/response.
What scoring tool helps identify severity in CAP?
CURB-65: Confusion, Urea >20, RR ≥30, BP <90/60, Age ≥65
What is the difference between colonization and infection in respiratory cultures?
Colonization: no symptoms; Infection: clinical illness and inflammation
What is the first-line antibiotic for outpatient CAP in a healthy adult with no comorbidities?
Amoxicillin 1 g TID or doxycycline 100 mg BID
When should a macrolide be used for outpatient CAP?
Only if local pneumococcal resistance to macrolides is <25%
What is the preferred regimen for inpatient CAP (non-ICU)?
Ceftriaxone + azithromycin OR a respiratory fluoroquinolone
What is the preferred empiric regimen for inpatient ICU CAP?
Beta-lactam (e.g., ceftriaxone) + macrolide or respiratory fluoroquinolone
When should MRSA coverage be added in CAP?
If prior MRSA infection/colonization, recent hospitalization + IV antibiotics, or severe illness (e.g., ICU)
When should Pseudomonas coverage be added in CAP?
If prior Pseudomonas infection, structural lung disease, or recent IV antibiotics
What drugs provide Pseudomonas coverage in pneumonia?
Cefepime, piperacillin/tazobactam, meropenem, aztreonam, ceftazidime
What are options for MRSA coverage in pneumonia?
Vancomycin or linezolid
What is a typical empiric regimen for HAP without risk factors?
Cefepime or piperacillin-tazobactam monotherapy
What is a typical empiric regimen for HAP with MRSA & Pseudomonas risk?
Vancomycin or linezolid + cefepime or piperacillin-tazobactam + amikacin or aztreonam (if high resistance)
What is the first-line antibiotic for outpatient CAP in a healthy adult with no comorbidities?
Amoxicillin 1 g TID or doxycycline 100 mg BID
When should a macrolide be used for outpatient CAP?
Only if local pneumococcal resistance to macrolides is <25%
What is the preferred regimen for inpatient CAP (non-ICU)?
Ceftriaxone + azithromycin OR a respiratory fluoroquinolone
What is the preferred empiric regimen for inpatient ICU CAP?
Beta-lactam (e.g., ceftriaxone) + macrolide or respiratory fluoroquinolone
