URI antibiotics

Question 1

Outpatient CAP

previously healthy

Answer 1

Macrolide

Doxycycline

Question 2

Pneumonia in Transplant pt most likely

Answer 2

Cytomegalovirus

RSV

Aspergillus

Mucormycosis

Question 2

atypical p organisms

Answer 2

chalmydia pneumoniae

mucoplasma penumoniae

legionella pneumophilia

Question 3

DOC for penuococcus

Answer 3

cefotaxime

ceftriaxone

(not cephalosporin)

Question 3

FQ spectrum

Answer 3

intracellular atypicals (mycoplasma, chlamydia, legionella_

second line for some mybacterials (MTB, MAC)

Question 4

treatment duration CAP

conditions

Answer 4

minimum 5 days

afebrile 48-72 hours, breathing without O2

(2 weeks for coagulase positive Staph or Pseudomonas)

Question 5

for Penicillin resistant strep pneumo MIC > 2.0mcg/ml

for non-meningeal infection?

Answer 5

Vanco and rifampin

non-miningeal = cefotaxime/ceftriaxone,

high dose ampicillin

carbapenems

flouroquinolone (levofloxacin, moxifloxacin)

Question 6

best anti-pneumoccocal FQ

Answer 6

levofloxacin

(also moxifloxacin)

Question 7

in patient CAP if pseudomonas is considered

Answer 7

a-penumococcal, a-pseudomonal B lactam

(piperacillin, tazobactan, cefepime, meropenem)
PLUS
a-pseudomonal flouroquinalone

Question 7

drugs for resistant gram positive bacteria

Answer 7

Vancomycin - not VRE (oral for c dif only)

**Linzezolid - **bone marrow suppression and neuropathy prolonged use

Daptommycin - not for use in pneumonia (bound by surfactant)

Question 7

CURB criteria for pneumonia,

Answer 7

Confusion

BUN >19mg/dL

RR >30breaths/min

Systolic < 60

Age 65

0-1=home

2= home or short inpt

3-5 = Admit, consider ICU

Question 7

Penicillin resistant (0.1<1.0)

treat with

Answer 7

high dose penicillin G or ampicillin,

cefotaxine /ceftriaxone

(otherwise pen G and amoxicill for MIC

Question 9

Inpt, non-ICU CAP with not PCN allergy

with allergy?

Answer 9

Beta lactam plus macrolide

a-pneumoccocal flouroquinolone

Question 11

inpatient, ICU CAP with no PCN allergy

with allergy

Answer 11

B-lactam plus macrolide

OR a pneumococcal floruroquinolone

a-penumoccoccal FQ

PLUS aztreonam

Question 12

extra side effectsm flouroquinolines

Answer 12

tendonitis

profoudn hypoglycemia

Question 12

Typical CAP organism

Answer 12

Strep pneumo

Haemophilus influenzae

Moraxella catarrhalis

Question 13

pneumonia in early HIV infection most likely

Answer 13

Step pneumo

Question 15

outpatient CAP

co-modbidities present

Answer 15

a-pneumococcal Flouroquinolone

B-lactam plus macrolide

Question 17

linezolid interacts with

Answer 17

antidepressents > 5HT syndrome

Question 18

most common causes of outpatient CA Pneumonia

Answer 18

Strep pneumo

mycoplasma pneumo

haemophilus influenzae

chlamydophila pneumo

resp viruses (influenza A+B, adenovirus, RSV, parainfluenza)

Question 18

DOC CAP with aspiration

Answer 18

add clindamycin to cover oral anaerobes

Question 18

General guidlines for emperic therapy
Typical,

Atypical

allergies

Answer 18

Typical = beta lactams

Atypical =Doxycycline or macrolides

For Beta lactam allergy, Flouroquinolones (levo, Moxi)

Question 19

pneumonia with exposure to rabbits most likely

Answer 19

francisella tularensis

Question 19

pneumonia with structural lung disease (cystic fibrosis, COPD, bronchiectasis)

Answer 19

Pesudomonas aeruginosa (esp Cystic fibrosis)

staph aureus

Non-tuberculous myobacteria

aspergillus

Question 20

extra side effects cepalosporins

Answer 20

altered mental status

Question 22

Tetracyclines spectrum (tetracycline, doxycycline, minocycline)

Answer 22

wide gram pos and gram negative strain atypicals - mycoplasma, legionella, chlamydia (tetracycline less effective, but cheaper) (minocycline more lipophilic - skin, soft tissue, bone infection)

Question 23

pneumonia with exposure to farm or parturient naimals

Answer 23

coxiella burnetti | (odd fever, infiltrate, cattle)

Question 25

macrolides spectrum (erythromycin, clarithromycin, azithromycin)

Answer 25

resp gram positive gram nega intracellular atypicals (mycoplasma, chalmydia, legionella)

Question 26

pneumonia with exposure to birds

Answer 26

chlaymdophila pistacci (parrots) avian influenza (poultry)

Question 28

best antipseudomonal FQ

Answer 28

ciprofloxacin | (also levofloxacin)

Question 29

late HIV infection Pneumonia (CD4

Answer 29

Pneuocystis jirovecii Non=tuberculous myubacteria Histoplasma

Question 30

Empiric Abs for HCAP without multidrug resistant risk factors

Answer 30

ceftriaxone amp/sulbactam ertapenemm Flouroquinolone

Question 32

CAP if MRSA suspected

Answer 32

Add vancomycin or linezolid

Question 33

hemoptysis + weight loss + homelessness =

Answer 33

tuberculosis

Question 34

empiric antibioitic for HCAP with multidrug resistant risk factors

Answer 34

**Anti-psuedomonal beta-lactam** PLUS **antipseudomondal fluroquinolone OR aminoglycoside** PLUS **Vanco or Linezolid if MRSA suspected**

Question 35

DOCs for invasive MSSA infections drugs NOT indicated

Answer 35

(Nafcillin) Oxacillin, Cefalozin NOT Quinolones (moxifloxacin,ciprofloxacin)

Question 36

beta lactam categories

Answer 36

**penicillins **- cillin **cephalosporins -** cef or ceph **carabpenems -** ertapenenm, meropenem, imipenem monobactams - aztreonam **beta-lactamase inhibitors - **calvuloanic acid, sulbactam

Question 38

DOC peusdomonas aeruginosa

Answer 38

piperacillin+Tazobactam Ceftazadime Cefepime Meropenen..Imipenem Aztreonam (mono bactam(

Question 39

risk factors penicillin reisstant strep pneumo

Answer 39

\>65 Beta lactam in last 3 months alcoholism comorbidities exposreu to child in day care

Question 40

most common inpatient, ICU CA pneumonia

Answer 40

S pneumonia staph areus legionalla gram negative bacilli H influenzae

Question 41

risk factors for HCAP

Answer 41

hospitalization \>5 days acute care \>2 days in past 90 days nursing home/long term care facility IV abxs, chemo, or wound care in past 30 days chronic dialysis within 30 days family member with multidrug resistant pathogen

Question 42

do not treat abnormal x-rays with antibiotics if patient does not have evidence of

Answer 42

systemic inflammation (fever, WBC, sputum production)

Question 43

most common inpatient, non-ICU CA pneumonia bacteria

Answer 43

Strep pneumonia Mycoplasma pneunmonia chlamydophila pneumonia H influenze, Legionalla aspiration Resp viruses (Flu A+B, adenovirus, RSV, parainfluenza

Question 44

for multi drug resistant strep pneumo

Answer 44

Vanco and rifampin clinadmucin, levofloxacin/moxfloxacin linezolid

Question 45

pneumonia with travel to SW US most likely

Answer 45

cocciciodes Hanta virus (four corners, acute pulmonary syndrome)