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33 Cards in this Set

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Empiric treatment of CAP outpatient and uncomplicated
a)azithromycin 500mg PO qd x3d or 2g PO x1
b)doxy 100mg PO BID x7-10d
Empiric treatment of CAP in adults outpatient and comorbidity (diabetes, COPD, CHF, etc.)
Fluoroquinolone or ketolide
a)Telithromcyin 800mg qd PO x7-10d
b)levofloxacin 750mg/d PO x5d
Empiric treatment of CAP in adults hospitalized patient
1)Levo 750mg IV/PO q24hr x7-10d

2)Ceftriaxone 1gm IV q24hr AND azithro 500mg IV/PO qd x3days
Empiric therapy for HAP
1)imipenem 500mg IV q6hr (if suspected legionella/ bioterrorism-AND FQ)

2)Zosyn 4.5gm IV q6hr OR cefepime AND tobramycin (ADD FQ if legionella/bioterror)
Duration of therapy for
a)CAP
b)HAP
a)7-14days (14 w/ anaerobes, atypicals)
b)7-14 (14-21 w/ pseudomonas)
Etiology of CAP
a)strep pneumo
b)mora catt
c)haem influ
d)mycoplasma
e)chlamydia species
f)legionella
g)staph aureus
Etiology of HAP
a)strep pneumo
b)haem influ
c)staph aureus
d)gram - bacilli (e.coli, kleb, pseudo, enterobacter, prot, serr, acinetobacter)
e)stenotrophomonas
f)anaerobes
What constitutes a MDR causing HAP?
1)antibiotic use in last 90days
2)current hospital stay >5days
3)immunosupp therapy/disease
4)area of resistance
5)risk factors for HAP
a)NH
b)chronic dial w/in 30days
c)home wound care
d)>2days in hospital in last 90days
Alcoholism
a)strep pneumo
b)anaerobes
COPD/smoking
a)strep pneumo
b)haemo influ
c)morax catt
d)legionella
poor dental hygience
anaerobes
HIV infection (early)
a)strep pneumo
b)haem influ
c)mycobacterium tb
suspected large volume aspiration
anaerobes
structural disease of lung (cystic fibrosis)
a)pseudomonas
b)burkholderia
c)staph aureus
injection drug use
a)strep pneumo
b)staph aureus
c)anaerobes
d)mycobacterium tb
airway obstruction
a)strep pneumo
b)staph aureus
c)haem influ
d)anaerobes
pneumococcus
penicillin
legionella
azithromycin
mycoplasma
doxycycline
haem influ
cefuroxime
chlamydia pneum
doxycycline
moraxella catar
cefuroxime
mouth flora
unasyn or clindamycin
psudomonas aeruginosa
piper AND gent
enterobacter
piper +/- gent
serratia
piperacillin
klebsiella
piperacillin
acinetobacter
imipenem
staph aureus
oxacillin/nafcillin
Aspiration pneumonia
clindamycin 600mg IV q8hr + fluoroquinolone
Influenza +/- superinfection
ceftriaxone or cefotaxime +/-oseltamivir 75 mg bid x 5 d
HAP empiric therapy low risk of MDR (4)
a)ceftriaxone 2 gm/d IV
b)levofloxacin 750 mg
c)Unasyn 2gm IV q6h
d)ertapenem 1 gm IV qd
HAP empiric therapy high risk of MDR
1)beta-lactam (antipseudomonal)AND
2) fluoroquinolone or aminoglycoside AND
3)vancomycin or linezolid

1)zosyn, imipenem, cefepime, ceftazidime
2)levo,cipro,gent,tobra, amikacin
3)vanco 15mg/kg IV q12hr or linezolid 600mg IV q12hr

Follow-up at 48-72h (clinically improved): cx negative - consider stopping abx; if cx positive - de-escalate, treat for 7-8d.

Follow-up at 48-72h (clinically unimproved): cx negative - look for alternative causes; cx positive - adjust abx.