Therapy of Pneumonia

Question 1

Pneumonia is one of the most common causes of:

Answer 1

1) Severe sepsis
2) Infectious cause of death

Question 2

Pneumonia’s clinical manifestations are most severe in:

Answer 2

1) The very young
2) The elderly
3) The chronically ill

Question 3

The most prominent pathogen causing community-acquired pneumonia (CAP) in otherwise healthy adults is:

Answer 3

Streptococcus pneumoniae

Question 4

Streptococcus pneumoniae causes:

Answer 4

Community-acquired pneumonia (CAP)

Question 5

What are some other common pathogens (besides Strep. pneumoniae)?

Answer 5

1) H. influenzae
2) Atypical pathogens:
a) Mycoplasma pneumoniae
b) Legionella sps
c) Chlamydia pneumoniae
3) Viruses, including influenza viruses

Question 6

The leading causative agents in hospital-acquired pneumonia (HAP) are:

Answer 6

1) Gram-negative aerobic bacilli
2) S. aureus
3) Multidrug-resistant (MDR) pathogens

Question 7

Ventilator-associated pneumonia (VAP) is
associated with:

Answer 7

Multidrug-resistant (MDR) pathogens

Question 8

In pneumonia that follows the aspiration of gastric or oropharyngeal contents, ____ are the most common etiologic agents.

Answer 8

Anaerobic bacteria

Question 9

Pneumonia in infants and children is caused mostly by:

Answer 9

Viruses

Question 10

Which viruses can cause pneumonia in infants and children?

Answer 10

1) RSV
2) Parainfluenza
3) Adenovirus

Question 11

____ is an important pathogen in older children.

Answer 11

Mycoplasma pneumoniae

Question 12

Beyond the neonatal period, what are the top 3 pathogens in order?

Answer 12

1) Strep. pneumoniae
2) Group A Streptococcus
3) Staph. aureus

Question 13

Why has H. influenzae type b become an infrequent cause of
pneumonia?

Answer 13

Because of the introduction of active vaccination against it

Question 14

Supportive care for pneumonia?

Answer 14

1) Humidified oxygen for hypoxemia
2) Bronchodilators when bronchospasm is present
3) Chest physiotherapy and postural drainage with evidence of retained secretions
4) Adequate hydration
5) Optimal nutritional support
6) Control of fever

Question 15

Recommendations are generally for __(specific/class of) antibiotics rather than for a specific drug.

Answer 15

Class of

Question 16

Recommendations for the management of CAP in adults depend on:

Answer 16

1) The treatment setting: inpatient or outpatient
2) The severity of infection
3) The presence of comorbidities
4) The presence of risk factors for drug-resistant pathogen

Question 17

All patients with CAP should be treated __ for bacterial infection.

Answer 17

Empirically

Question 18

Any patient with CAP who was recently exposed to one class of antibiotics should be treated using:

Answer 18

A different class

Question 19

Risk factors for MRSA and P. aeruginosa include:

Answer 19

1) Prior respiratory isolation of the pathogen
2) Hospitalization with administration of parenteral antibiotics within the last 3 months
3) Locally validated risk factors for these pathogens and prevalence of MRSA or P. aeruginosa in CAP patients

Question 20

In outpatient settings of CAP pneumonia, patients without comorbid conditions or risk
factors for drug-resistant pathogens should take:

Answer 20

Monotherapy with Amoxicillin, Doxycycline, or a Macrolide (Azithromycin or Clarithromycin)

Question 21

Macrolide monotherapy has shown resistance and should not be used if the local rate of
resistance of Pneumococcus is greater than __%.

Answer 21

25%

Question 22

In outpatient settings of CAP pneumonia, patients with comorbid conditions or risk
factors for drug-resistant pathogens should take:

Answer 22

1) Monotherapy with a respiratory Fluoroquinolone
(Levofloxacin, Moxifloxacin, or Gemifloxacin)

OR

2) Combination therapy with (Amoxicillin-Clavulanate or a Cephalosporin) + (A Macrolide
or Doxycycline)

Question 23

Inpatient setting of CAP pneumonia patients recommendations are based on:

Answer 23

1) Severity of pneumonia
2) Prior respiratory isolation of MRSA or P. aeruginosa
3) The presence of risk factors for these pathogens

Question 24

For inpatients with non-severe pneumonia use:

Answer 24

1) Beta-lactam + Macrolide

OR

2) A respiratory Fluoroquinolone alone.

Question 25

Alternative treatment for inpatients with non-severe pneumonia?

Answer 25

Beta-lactam + Doxycycline

Question 26

For inpatients with severe pneumonia, use:

Answer 26

Beta-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) + A macrolide (azithromycin) or a Fluoroquinolone

Question 27

Don’t use ___ for Acinetobacter VAP

Answer 27

Tigecycline

Question 28

Acinetobacter HAP/VAP = use:

Answer 28

Carbapenem or Ampicillin/sulbactam

Question 29

Resistant Acinetobacter HAP/VAP = use:

Answer 29

Inhaled Polymyxin B AND IV Colistin