Respiratory infections

Question 1

What are common respiratory system infections?

Answer 1

CAP

HAP

Question 2

What are symptoms of CAP?

Answer 2

-Shortness of breath.
-Coughing.
-Heavy sputum.
-Fever and chills.
-Chest pain that is worse when you breathe or cough.
-Upper belly (abdomen) pain with nausea, vomiting, or diarrhea.

Question 3

What tool would be used to determine if a patient with CAP should be referred to hospital and what ABX to given?

Answer 3

CRB-65

-C=Confusion (new disorientation in person, place, or time; or abbreviated mental test score 8 or less)

R=Raised respiratory rate (30 breaths per minute or more)

B= Low blood pressure (diastolic 60 mmHg or less, or systolic less than 90 mmHg).

65 years or more.

A score of 0 corresponds to a low risk of death (less than 1% mortality risk), a score of 1 or 2 to intermediate risk (1–10% mortality risk), and a score of 3 or 4 to high risk (more than 10% mortality risk).

Question 4

CAP
both CRB65 score of 0 and low severity

Answer 4

Amoxicillin 500mg TDS for 5 days

Doxycycline 200mg day 1 and 100mg for 4 days

clarithromycin 500 mg twice a day for 5 days
or

oral erythromycin (in pregnancy) 500 mg four times a day for 5 days.

Question 5

CAP
What antibiotic should be used for CRB65 score of 1 or 2 and moderate severity?

Answer 5

Prescribe oral amoxicillin 500 mg three times a day for 5 days

and

(if atypical pathogens suspected)
oral clarithromycin 500 mg twice a day for 5 days, or oral erythromycin (in pregnancy) 500 mg QDS for 5 days.

Alternatively, in penicillin allergy, oral doxycycline 200 mg on the first day then 100 mg once a day for 4 days (total course of 5 days), or

oral clarithromycin 500 mg twice a day for 5 days

Question 6

What is treatment for CAP for patients 12-17 years non-severe ?

Answer 6

First choice oral antibiotic is amoxicillin 500 mg three times a day for 5 days

a penicillin allergy or amoxicillin is unsuitable
oral clarithromycin 250 mg to 500 mg twice a day for 5 days
or

oral erythromycin (in pregnancy)
250 mg to 500 mg four times a day for 5 days,

or

oral doxycycline 200 mg on the first day, then 100 mg once a day for 4 days

Question 7

What does the CRB65 score determine?

Answer 7

Score of 3 or more, arrange urgent admission to hospital.

Score of 1 or 2, hospital assessment should be considered (particularly for people with a score of 2).

Score of 0, treatment at home should be considered, depending on clinical judgement and the person’s social circumstances.

Question 8

HAP

What is first line treatment option for non-severe?

Answer 8

Co-amoxiclav 500mg/125mg TDS 5 days

OR

doxycycline
cefalexin
co-trimoxazole
levofloxacin

Question 8

HAP

What is it?

Answer 8

Pneumonia that develops 48 hours or more after hospitalisation.

Question 9

HAP
What is first line treatment option for severe HAP? e.g sepsis

Answer 9

IV for 48 hours then switch to oral if possible:
Piperacillin with tazobactam-4.5g TDS (or QDS if severe)
Ceftazidime 2g TDS
Ceftriaxone 2g OD
Cefuroxime
Meropenem
Ceftazidime with avibactam 2/0.5g TDS
Levofloxacin

Question 10

HAP:
What is first line treatment in children non-severe?

Answer 10

Co-amoxiclav

second line-
clarithromycin

Question 11

HAP:
What is treatment for severe pneumonia in children

Answer 11

Piperacillin tazobactam
Ceftazidime
Ceftriaxone

Question 12

HAP
What antibiotics are added if suspected or confirmed MRSA infection?

Answer 12

Teicoplanin
Vancomycin
Linezolid