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31 Cards in this Set
- Front
- Back
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Most common bugs to cause Sinusitis
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Mainly Viral
Strep pneumonia H. influenza M. Catarrhalis |
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Treatment options for Sinusitis
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Symptomatic Treatment:
hydration, analgesics, antipyretics, saline irrigation, and intranasal corticosteroids Do NOT use oral decongestants and/or antihistamines 1st Line: Augmentin 2nd Line: Doxycycline, Respiratory FQ Resistant: high dose Augmentin Do NOT use: Bactrim Macrolides 2nd and 3rd gen Cephalosporins |
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Signs and Symptoms Requirement before treatment for Sinusitis?
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S/S Sinusitus
1. Persistent/not improving (>10 days) 2. Severe (>3-4 days) 3. Worsening (>3-4 days) |
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Risk factors for Resistance
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1. <2 or >65 yoa; daycare
2. ABX within 1 month 3. hospitalization in past 5 days 4. Comorbidities 5. Immunocompromised Treatment duration with risk of resistance: 7-10 days of ABX |
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Organisms causing Acute Bronchitis
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Bordetella pertusis
Mycoplasma pneumonia Chlamydia pneumoniae |
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Organisms causing Chronic Bronchitis
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H. influenza
H. parainfluenzae M catarrhalis Pneumococcus |
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When do you treat Acute Bronchitis?
How do you treat it? |
NO antibiotics or mucolytics
Supportive care: antipyretics, fluids, inhaled bronchodilators ABX if... 1. Persistent fever or s/s >4-6 days 2. Predisposed pts (elderly, immunocompromised) |
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Difference between Acute and Chronic Bronchitis
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Acute:
BORDETTELA PERTUSSIS, MYCOPLASMA PNEUMONIA, CHLAMYDIA PNEUMONIA sore throat, malaise, HA >5 days to weeks Non productive or productive cough CXR is clear Chronic: H. INFLUENZA, H. PARAINFLUENZAE, M. CAT, PNEUMOCOCCUS Coughing up of sputum on most days for at least 3 months each year for 2 consecutive years Excessive, thick, purulent CXR is clear, but Barrel chest |
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What is considered moderate Bronchitis and how do you treat it?
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Moderate (> or = 2 symptoms without risk factors)
-increased dyspnea -increased sputum production -increased sputum purulence Extended Spectrum Cephalosporin: Cefdinir Cefprozil Cefuroxime Advanced macrolide: Azithromycin Clarithromycin Tetracyclines: Doxycycline |
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What is considered severe Bronchitis and how do you treat it?
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Severe (> or = 1 risk factor- obviously w/ symptoms)
Age > or = 65 yo FEV < or = 50% 4 episodes of AECB/ year 1 or more comorbidities Treatment: High dose Augmentin Respiratory FQ |
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What characterizes the influenza?
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ABRUPT ONSET OF SYMPTOMS:
High fever Nonproductive cough malaise rhinitis sore throat MUSCLE ACHES headaches uncomplicated influenza lasts for 3-7 days cough and malaise may last >2 weeks |
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When are you at risk of complications from the Influenza?
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Morbidly obese
American Indian/ Alaska Native Age <5 and >65 Chronic Conditions Immunosuppression Pregnant or Postpartum (2 weeks) Age <18 with long term ASA Resident of LTCF |
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What are the different types of Influenza and which one is predominate?
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Predominate= Pandemic A (H1N1)
Others: Seasonal A (H1N1) Seasonal A (H3N2) Influenza B |
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Who is indicated to receive the Influenza Vaccine?
What populations are most important to receive it? |
All persons > or = 6 months of age
Children: 6 months- 4yrs > or = 50 years of age Chronic medial conditions immunocompromised Nursing home residents and chronic care facilities Pregnant women Age <18 receiving long term ASA therapy Health care personnel caregivers of high risk people caregivers of children <5 and >50 American Indians/ Alaska Natives BMI > or = 40 |
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What is the difference between the TIV vs LAIV?
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Trivalent Influenza Vaccine (TIV):
killed (can't cause influenza) indicated for > or = 6 months of age route is IM or intradermal (only 18-64 yo Contraidicated if history of Guillain-Barre syndrome or if there is current fever Live Attenuated Influenza Vaccine (LAIV): Live Indicated for ages 2-49 Intranasal Contraindicated if pt has asthma, is immunodeficient, on long term ASA treatment, Guillain-Barre Syndrome, pregnant, current fever, or nasal condition that makes breathing difficult |
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What is the dosing for Zanamivir?
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Zanamivir (Relenza) 10mg (2 inhalations) BID
initiate within 48 hours of onset of symptoms to be effective in immunocompetent patients |
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What is the dosing for Oseltamivir?
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Oseltamavir (Tamiflu) 75mg PO BID
initiate within 48 hours of onset of symptoms to be effective in immunocompetent patients |
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Describe Community Acquired Pneumonia (CAP)
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Not hospitalized or in LTCF for >14 days before onset
1. s. pneumoniae 2. m. catarrhalis 3. H. influenza 4. Mycoplasma pneumonia 5. Chlamydia pneumonia 6. Legionella 7. K. pneumonia 8. S. aureus 9. Pseudomonas aeroginosa Viral: 10. Influenza A and B, H1N1 11. RSV (usually kids) Treatment Duration for CAP= 5-7 days |
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Describe Aspiration Pneumonia (AP)
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material from the stomach or URT into the LRT or oropharyngeal bacteria
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Describe Hospital Acquired Pneumonia (HAP)
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Occurs > or = 48 hrs after admission
Potential Pathogens needing only Limited Spectrum: 1. strep. pneumoniae (early onset) 2. H. influenzae (early onset) 3. MSSA 4. E. coli 5. K. pneumonia 6. Enterobacter sp 7. proteus sp 8. serratia marcescens Potential Pathogens needing Broad Spectrum: 1. P. aeruginosa 2. K. pneumoniae 3. Acinetobacter sp Oral Chlorhexadine may be helpful Treatment Durations for HAP= 7-10 days |
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Describe Healthcare Associated Pneumonia (HCAP)
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Any patient who has:
1. hospitalized for > or = 2 days in last 90 days 2. LTCF 3. received IV ABX 4. Chemotherapy 5. Wound care within past 30 days 6. attended a hospital or dialysis center |
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Describe Ventilator Associated Pneumonia (VAP)
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Arises >48-72 hrs after endotracheal intubation
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How to treat CAP?
Empiric Outpatient Healthy Empiric Outpatient with co-morbidities Empiric Inpatient no in ICU Empiric Inpatient in ICU or incubated Community Acquired MRSA |
Empiric Outpatient Healthy- Advanced Macrolide OR Doxycycline; Alt. Respiratory FQ
Empiric Outpatient with co-morbidities- Macrolide + Beta-lactam OR Respiratory FQ Empiric Inpatient no in ICU- Respiratory FQ OR IV beta lactam + Advanced macrolide OR doxycycline Empiric Inpatient in ICU or incubated: IV beta lactam OR IV beta lactam + IV respiratory FQ OR IV Aztreonam + IV respiratory FQ Community Acquired MRSA: Clindamycin OR Vancomycin (but Gauthier says it doesn't go in lungs) OR Linezolid |
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How to treat Aspiration Pneumonia
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Same as normal coverage, but ADD Clindamycin
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What is the most common cause of HAP?
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Pseudomonas aeruginosa
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What is the most common cause of VAP?
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Pseudomonas aeruginosa
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Early onset HAP is usually caused by
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Streptococcus pneumoniae
H. influenza |
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HAP Limited Spectrum vs. HAP Broad Spectrum
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Limited Spectrum:
Ceftriaxone OR Levofloxacin, Moxifloxacin, Cipro OR Ampicillin/sulbactam OR Ertapenem Broad Spectrum: (2 drugs) Antipseudomonal cephalosporin OR Antipseudomonal carbapenem OR Antipseudomonal beta lactam/ beta lactam inhibitor PLUS Antipseudomonal FQ or AG |
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Used to treat HA-MRSA pneumonia
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Linezolid OR Vancomycin
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Used to treat Legionella pneumonphila pneumonia
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Macrolide OR FQ
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What are the Guidelines for Pneumococcal Vaccine?
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1. > 65 yoa
2. < 65 yoa w/... chronic cardiovascular, pulmonary, renal, or liver disease diabetes mellitus cerebrospinal fluid leaks alcoholism asplenia immunocompromising conditions/ medications native america/ alaska natives long term care facility residents 3. Current Smoker 4.One time re-vaccination after age 65 if last vaccine given longer than 5 years ago |
