thera final pneumonia

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coal
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272153
Filename:
thera final pneumonia
Updated:
2014-05-03 20:44:11
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thera final pneumonia
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thera final pneumonia
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thera final pneumonia
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  1. risk factors of pneumonia
    • > 65 years old
    • immunocompromised
    • recent treatment with abx
    • comorbidities
    •   COPD
    •   cerebrovascular disease
    •   chronic renal disease
    •   diabetes
    •   heart failure
    •   hepatic disease
  2. clinical symptoms of pneumonia
    • dyspnea
    • tachypnea/tachycardia
    • hypoxia
    • rust-colored sputum
    • chest radiograph or other imaging technique demonstrating infiltrate is REQUIRED
  3. procalcitonin
    • elevated in presence of bacterial infection
    • rises w/I 6-12 hrs of infection
    • normal < 0.05 ng/mL
    • treat when > 0.25
    • take at initial presentation
    • monitor days 3,5,7 for deescalation
  4. severity of illness score
    • CURB-65
    • Confusion
    • Uremia
    • Respiratory rate
    • low Blood pressure
    • age 65 years or greater
    • 2 or more = hospitalization
  5. outpatient treatment for previously healthy, no risk factors for drug-resistant S. pneumoniae
    • macrolide
    •   azithromycin
    •   clarithromycin
    •   erythromycin (more GI SE)
    • alternate
    •   doxycycline
  6. risk factors for drug resistant S. pneumoniae
    • chronic heart, lung, liver or renal disease
    • alcoholism
    • malignancy
    • asplenia
    • immunosuppressed
    • use of antimicrobials w/I previous 3 months
  7. outpatient treatment if risk factors for drug-resistant S. pneumoniae
    • respiratory fluoroquinolone
    •   moxifloxacin
    •   gemifloxacin
    •   levofloxacin
    • OR
    • beta-lactam + macrolide
    •   amoxicillin or augmentin preferred
  8. inpatient, non-ICU treatment of S.pneumoniae
    • respiratory fluoroquinolone
    • beta lactam + macrolide
    •   cefotaxime, cetriazone, ampicillin, ertapenem
  9. inpatient, ICU treatment of S. pneumoniae
    • beta lactam + either azithromycin or FQ
    •   preferred: cefotaxime, cefepime, imipenem, meropenem
  10. 5 criteria to switch from IV to PO
    • hemodynamically stable
    • improving clinically
    • able to ingest medication
    • normal function of GI tract
    • clinical stability
    •   temp < 37.8
    •   HR < 100
    •   RR < 24
    •   SBP > 90
    •   O2 > 90
    •   normal mental status
  11. who should receive the influenza vaccine
    > 6 months
  12. who should receive the pneumococcal vaccine
    • > 65 yo
    • current smokers
    • high risk 2-64
  13. who should receive tetanus toxoid
    19-64 yo
  14. definition of HAP
    PNA that occurs > 48 hours after admission, not incubating at admission
  15. definition of CAP
    PNA that does not meet any of the other definitions
  16. definition of VAP
    PNA that arises > 48 hours after intubation
  17. definition of HCAP
    • 1) hospitalized in acute care hospital for 2+ days within previous 90 days
    • 2) resides in nursing home or long term care facility
    • 3. IV abx, chemo or wound care w/I 30 days
    • 4) attended hospital
    • 5) attended hemodialysis clinic
  18. risk factors for MDR pathogens
    • antimicrobial therapy in previous 90 days
    • current  hospitalization of 5+ days
    • high rate of resistance
    • risk factors for HCAP
    • immunocompromised
  19. durations of therapy
    we only need 7 days worth

    if non-lactose fermenting P. aeruginos aro acinetobacter treat for 14 days
  20. FDA approval of aerosolized antibiotics
    cystic fibrosis

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