What is the recommended treatment for a pneumonia patient with severe disease, no MRSA risk (not HCAP or VAP) and risk factors for pseudomonas aeruginosa?
Cefipime 2 gm IV Q 8 hrs
or
Imipenem/Cil. 500-1000 mg IV Q 6hrs
or
Meropenem 1 gm IV Q 8hrs
or
Piperacil./tazobact. 3.375 gms IV Q 6hrs
PLUS
Cipro or aminoglycoside with wither azithromycin or levofloxacin
What is the recommended treatment for a pneumonia patient with severe disease, MRSA risk (HCAP or VAP) and risk factors for pseudomonas aeruginosa?
Cefipime 2 gm IV Q 8 hrs
or
Imipenem/Cil. 500-1000 mg IV Q 6hrs
or
Meropenem 1 gm IV Q 8hrs
or
Piperacil./tazobact. 3.375 gms IV Q 6hrs
PLUS
Cipro or aminoglycoside with wither azithromycin or levofloxacin
PLUS VANCO
What is the target trough for Vancomycin in pneumonia?
15-20
What are the benefits of antibiotic de-escalation?
Decreased resistance
Decreased risk for antibiotic related side effects
Decreased cost
How does the IV dose of Levo compare to the PO dose?
Same
How does the IV dose of Ceftriaxone compare to PO?
No equivalent PO dose
What is the only group of antibiotics that can orally cover pseudomonas?
Quinolones
How does the IV dose of Piperacillin/Tazobactam compare to the PO dose?
No PO equivalent
What drugs have equivalent IV and PO doses?
Doxycycline
Ofloxacin
Ciprofloxacin
Levofloxacin
Metronidazole
Clinadmycin
Trimethroprim/Sulfamethazole
When can you switch from IV to PO meds in the treatment of pneumonia?
<100 F
Functioning GI
Decreasing WBC
Improvement in cough and dyspnea
What is the duration of treatment for CAP?
7-10 days (exception: Levo 750 QD or Azithro 500 QD can stopped after 5 days)
What is the duration of treatment for HCAP, VAP and HAP?
7-14 days
Pseudomonas or Staph aureus present: 21 days
How can pneumonia be prevented?
Influenza vaccine annually
One time Pneumonia vaccine
Who should get a Pneumonia vaccine?
All adults over 65
Smokers (any age)
> 6 years of age with chronic illness
> 6 with immunosuppressive drug therapy
What tests should be performed on in patient pediatrics with pneumonia?
Blood and sputum cultures
CBC
Chest x-ray
What I sthe empiric treatment for children with suspected bacterial pneumonia?
Inflants and pre-school age:
Outpatient: Amoxacillin
Inpatient: Ceftriaxone or Cefotaxime
School age:
Outpatient: Macrolide
Inpatient: Beta lactam + Macrolide
Why are school age children with pneumonia treated differently than pre-school age?
5-50 years = higher risk of mycoplasma
What is the treatment duration for pediatrics with pneumonia?
7-10 days
Acute bronchitis is located on what part of the lungs?
Bronchioles
Pneumonia is located in what part of the lungs?
Aveoli
What are the supportive treatments for acute bronchitis?
APAP/IBU
Cough suppressant only at night
When should a patient receive antibiotic therapy for acute bronchitis?
HR > or = 100
Elevated procalcitonin
Symptoms beyond 2 weeks
> 65 years
What are the most common Bacterial pathogens impictaed in Acute bronchitis?
H flu
S pneumonia
M catarrhalis
What are the usual antibiotic choices for acute bronchitis?