Management of respiratory tract infections Flashcards
(25 cards)
What is a mnemonic letter to remember the key symptoms and management approach of Acute Bacterial Rhino-Sinusitis (ABRS)?
A: “F”
•
Facial pain
• Fatigue
• Fever
• Fullness in ear
• Foul drainage (nasal/postnasal)
• Function loss of smell (Hyposmia/Anosmia)
• Failed culture (→ Empiric treatment)
What are the common bacterial pathogens and their prevalence rates in Acute Bacterial Rhinosinusitis (ABRS)?
A:
• Streptococcus pneumoniae: 20–43%
• Haemophilus influenzae: 22–36%
• Moraxella catarrhalis: 2–16%
• Staphylococcus aureus: 10–13%
• Streptococcus pyogenes: 3%
What is the first-line treatment for ABRS and how is it adjusted in patients with risk factors for resistance?
A:
• First-line: Amoxicillin or Amoxicillin/Clavulanate.
• If risk factors for resistance:
• Use high-dose oral Amoxicillin
• Or high-dose Amoxicillin/Clavulanate
Why is clavulanate added to amoxicillin in ABRS treatment, and in whom is its use better supported?
A:
• Clavulanate improves coverage against ampicillin-resistant H. influenzae and M. catarrhalis.
• Its use is better supported in children than in adults.
Why are macrolides (azithromycin/clarithromycin) and trimethoprim-sulfamethoxazole not recommended in ABRS?
A: Because of high resistance rates of Streptococcus pneumoniae to these antibiotics.
What are treatment options for patients with penicillin allergy in ABRS?
A:
• Oral doxycycline
• 3rd generation oral cephalosporin (e.g., cefixime) ± clindamycin
Why are respiratory fluoroquinolones (levofloxacin, moxifloxacin) reserved for ABRS patients with no alternative treatment options?
A: Because they carry a risk of serious adverse effects such as
Tendonitis and tendon rupture, neuropathies, and gait disturbance.
What are the risk factors for pneumococcal resistance?
A:
• Regions with >10% penicillin-non-susceptible S. pneumoniae
• Age ≥ 65 years
• Hospitalization in last 5 days
• Antibiotics use in previous month
• Immunocompromise
• Multiple comorbidities (DM, liver, kidney, heart diseases)
• Severe infection
In what percentage of Community Acquired Pneumonia (CAP) cases is the definitive microbiologic cause identified?
A: Less than 50% of CAP cases have a definitive microbiologic etiology identified.
What are the typical pathogens in Community Acquired Pneumonia (CAP) and their special considerations?
A:
• Streptococcus pneumoniae: most common pathogen
• Haemophilus influenzae
• Moraxella catarrhalis
• Staphylococcus aureus: unlikely cause, mainly post-influenza infection
• Pseudomonas & Klebsiella: seen in alcoholism, bronchiectasis, and diabetes mellitus patients
What is the key principle in the treatment plan of Community Acquired Pneumonia (CAP)?
A:
• Start rapid empiric antibiotics promptly
• Ensure adequate coverage for Streptococcus pneumoniae and atypical pathogens
What is the outpatient treatment for CAP in patients with no comorbidities?
A: Amoxicillin, Macrolide, or Doxycycline.
What is the outpatient treatment for CAP in patients with comorbidities?
(Beta-lactam: amoxicillin/clavulanate or cefuroxime) + macrolide
or doxycycline
Respiratory fluorquinolones: levofloxacin or moxifloxacin
What are the risk factors for Pseudomonas infection in CAP?
A: Structural lung disease, COPD, and bronchiectasis.
What is the treatment if Pseudomonas is suspected in CAP?
Use anti-pneumococcal and anti-pseudomonal beta-lactams such as Piperacillin/tazobactam, Cefepime, Meropenem, or Imipenem.
What antibiotic is used in CAP patients with severe penicillin allergy?
A: Aztreonam.
What is the recommended duration of therapy for CAP?
A:
• Uncomplicated CAP: 5 days
• CAP with suspected/proven Pseudomonas or MRSA: 7 days
What are the common causative organisms of Hospital-Acquired Pneumonia (HAP)?
A:
• Pseudomonas aeruginosa
• Staphylococcus aureus (including MSSA & MRSA)
• Klebsiella pneumoniae
• Escherichia coli (E. coli)
• Acinetobacter species
• Serratia marcescens
• Stenotrophomonas maltophilia
What are the common causative organisms of Ventilator-Associated Pneumonia (VAP)?
A:
• Pseudomonas aeruginosa
• Staphylococcus aureus (MSSA & MRSA)
• Stenotrophomonas maltophilia
• Acinetobacter species
• Enterobacteriaceae (less commonly seen in VAP)
How is suspected Ventilator-Associated Pneumonia (VAP) managed empirically?
A:
• Empiric therapy should cover S. aureus, Pseudomonas, and other gram-negative bacilli (GNB)
• The causative organism is usually unknown, so empiric treatment is essential
• Use Vancomycin or Linezolid to cover MRSA, guided by the local antibiogram
• Recommended duration of therapy: 7 days
What antibiotics are used for empiric and confirmed MSSA coverage?
A:
• Empiric MSSA coverage:
• Piperacillin-tazobactam
• Cefepime
• Levofloxacin
• Imipenem
• Meropenem
• Confirmed MSSA infection:
• Oxacillin
• Nafcillin
• Cefazolin
What are the risk factors for MDR pathogens in HAP/VAP? (1–3)
A:
- IV antibiotic use within the preceding 90 days
- Septic shock at the time of VAP
- Acute respiratory distress syndrome (ARDS) before VAP
What are the risk factors for MDR pathogens in HAP/VAP? (4–6)
A:
- ≥5 days of hospitalization before VAP onset
- Acute renal replacement therapy before VAP
- ICU location with >10% resistance among Gram-negative isolates or lacking local antibiogram data
What is the recommended treatment approach for HAP/VAP in patients with risk factors for multi-drug resistant (MDR) pathogens?
Double drug coverage of P.aeruginosa, should combine agents with a
high degree of anti-pseudomonal activity and low resistance potential
