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Second Chance - CAP

What differentiates between CAP vs HAP/VAP? (MULTI ANSWER)
No hospitalized within past 90 days for at least 2 days
No Hemodialysis
Not in Nursing home resident or LTAC
No chronic wound care
Currently hospitalized
On antibiotics
What organisms can cause CAP? (MULT ANS)
S. pneumoniae
H. influenzae
Legionella pneumophila
Viral
E. Coli
Klebsiella
What is the minimum CURB score for inpatient treatment of CAP?
0
1
2
3
4
5
6
What are the components of CURB scoring? (MULTI)
Confusion
Uremia BUN >20
RR at least 30
BP <90 SPB or <60 DBP
Age at least 65YO
Fever
HR at least 100 BPM
Risk Factors for Drug Resistant S.pneumoniae include: (MULTI)
Age < 2 or ≥ 65 yo
Alcoholism
Presence of co-morbidities (chronic heart, lung, liver, renal disease)
Diabetes
Immunosuppression (malignancy, asplenia, medications)
Use of antibiotics within previous 3 months
Exposure to a child in day care
Illicit drug use
Healthcare worker
What options are available for non-DRSP treatments as outpatient? (MULTI)
Azithromycin 500 mg PO day 1, 250 mg PO QD x 4 days
Clarithromycin 500 mg PO BID x 7 days
Doxycycline 100mg PO BID x 7 days
Moxifloxacin 400mg PO x 7 days
Levoflox 750mg PO QD x 5 days
What options are available for DRSP treatments as outpatient? (MULTI)
Azithromycin 500 mg PO day 1, 250 mg PO QD x 4 days
Clarithromycin 500 mg PO BID x 7 days
Doxycycline 100mg PO BID x 7 days
Moxifloxacin 400mg PO x 7 days
Levoflox 750mg PO QD x 5 days
Amox 1g PO TID x 7d + Z-Pak
Cefdinir 300 mg BID x 7d + Z-pak
What options are available for DRSP treatments as inpatient? (MULTI)
Azithromycin 500 mg PO day 1, 250 mg PO QD x 4 days
Clarithromycin 500 mg PO BID x 7 days
Doxycycline 100mg PO BID x 7 days
Moxifloxacin 400mg PO x 7 days
Levoflox 750mg PO QD x 5 days
Moxifloxacin 400 mg PO/IV daily for ≥ 5 days
Levofloxacin 500-750 mg PO/IV daily for ≥ 5 days
Ceftriaxone (1-2 g IV q24h) for ≥ 5 days + Azithromycin 500 mg IV for ≥ 5 days
Adverse effects of: Azithromycin/Clarithromycin (MULTI)
Metallic taste (clarithromycin)
QTc prolongation
NVD
GI ADE
Tendon rupture
Photosensitivity
Seizures
Adverse effects of: FQs (MULTI)
Metallic taste (clarithromycin)
QTc prolongation
NVD
GI ADE
Tendon rupture
Photosensitivity
Seizures
Adverse effects of doxy? (MULTI)
Photosensitivity
Esphogeal erosion (sit upright 30min)
NVD
QTc prolongation
Patients need 3 minor criteria for severe CAP, what are major criterias that would automatically classify into severe CAP? (MULTI)
Invasive mechanical ventilation
Septic shock – need of vasopressors
Thrombocytopenia
Hypotension requiring aggressive fluids
What qualifies as an adequate specimen? (MULTI)
> 25 WBCs / hpf
< 10 epithelial cells / hpf
A predominant organism on Gram stain
Heavy growth of a single species on culture
< 25 WBCs / hpf
> 10 epithelial cells / hpf
Several organisms indicating normal flora
Lack of a single predominant organism
Patients should be switched from IV to PO when: (MULTI)
Hemodynamically stable
Clinically improving
Able to ingest oral medications
Have a normal functioning GI tract
About to be discharged
Request oral meds
 
Definitive tx for PCN-susceptible s. Pneumoniae include: (MULTI)
Penicillin 2-4 million units IV q4-6 hours
Pen VK 500 mg four times daily
Amoxicillin 500 mg – 1 g three times daily
Ceftriaxone 1 gram IV daily (ceftriaxone MIC ≤ 1 mcg/mL)
Levofloxacin 750 mg IV daily
Amoxicillin 1 g TID (PCN MIC ≤ 4 mcg/mL)
Levofloxacin 750 mg PO daily
Linezolid 600 mg PO BID
Definitive tx for PCN-resistant s. Pneumoniae include: (MULTI)
Penicillin 2-4 million units IV q4-6 hours
Pen VK 500 mg four times daily
Amoxicillin 500 mg – 1 g three times daily
Ceftriaxone 1 gram IV daily (ceftriaxone MIC ≤ 1 mcg/mL)
Levofloxacin 750 mg IV daily
Amoxicillin 1 g TID (PCN MIC ≤ 4 mcg/mL)
Levofloxacin 750 mg PO daily
Linezolid 600 mg PO BID
What should be min the total duration of therapy for inpatient CAP (in days)?
5
7
14
21
ICU Treatment of CAP can be: (MULTI)
Ceftriaxone + azithromycin
Ceftriaxone + moxifloxacin/levofloxacin
Aztreonam + moxifloxacin/levofloxacin
Cetriaxone + doxycycline
Definitive tx for Legionella include: (MULTI)
Penicillin 2-4 million units IV q4-6 hours
Pen VK 500 mg four times daily
Amoxicillin 500 mg – 1 g three times daily
Ceftriaxone 1 gram IV daily (ceftriaxone MIC ≤ 1 mcg/mL)
Azithromycin 500 mg IV – then 500 mg PO daily x 7-10 d.
Levofloxacin 750 mg IV – then 750 mg PO daily x 10 d
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