Respiratory Infections

Question 1

Describe the CURB65 score for pneumonia.

Answer 1

C - confusion
U - urea: 7+
R - respiratory rate: 30+
B - BP: <90/60
65 - over 65+ yo

Question 2

Which antibiotics would you give for non-severe community acquired pneumonia (CAP), with a CURB65 score of 0-1?

For how long?

Answer 2

Amoxicillin, OR
Doxycycline, OR
Clarithromycin

Duration: 7 days

Question 3

Which antibiotics would you give for non-severe community acquired pneumonia (CAP), which a CURB65 score of 2?

What would you give in the case of true penicillin allergy?

For how long?

Answer 3

Amoxicillin, PLUS
Doxycycline OR clarithromycin

In penicillin allergy: ONLY clarithromycin

Duration: 7 days

Question 4

Which antibiotics would you give for severe community acquired pneumonia (CAP)?

What would you give in the case of true penicillin allergy?

For how long?

Answer 4

IV/oral clarithromycin, PLUS
IV amoxillin OR IV co-amoxiclav

In penicillin allergy: IV/oral levofloxacin

Duration: 7-10 days (up to 14 days if atypical organisms suspected)

Question 5

How would you define severe CAP?

Answer 5

CURB65 score: 3+

OR

CAP with sepsis

Question 6

Which antibiotics would you give for hospital acquired pneumonia? What if:

a) It occurs within 4 days of admission
b) It occurs 5+ days after admission and is i) non-severe or ii) severe

For each, state how long to continue treatment, and by which route to administer it.

Answer 6

WITHIN 4 DAYS ADMISSION:
Treat as CAP
Duration: 7 days

5+ DAYS AFTER ADMISSION:
Non-severe:
-Oral co-amoxiclav, OR
-Oral doxycycline
-Duration: 7 days

Severe:

• IV amoxicillin, PLUS
• IV aztreonam
• Duration: 7-10 days (up to 14 if atypical bacteria suspected)

Question 7

Which antibiotics would you give for infectious exacerbations of COPD, or LRTIs?

For how long?

What is the only indication for antibiotic therapy in this case?

Answer 7

Oral amoxicillin, OR
Oral doxycycline, OR
Oral clarithromycin

Duration: 5 days

Indication: purulent sputum

Question 8

Which antibiotics would you give for uncertain diagnosis of LRTI/UTI?

For how long?

Answer 8

Oral doxycycline, OR
Oral amoxicillin

Duration: 5 days

PLUS oral trimethoprim

Duration: 3 days in females, 7 days in males

Question 9

Which antibiotics would you give for severe/complicated infectious exacerbations of COPD?

For how long?

Answer 9

IV amoxicillin, OR
IV clarithromycin

Duration: 7 days

Question 10

Which antibiotics would you give for aspiration pneumonia?

For how long?

Answer 10

IV metronidazole, PLUS
IV amoxicillin OR IV clarithromycin

Duration: 7 days