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23 Cards in this Set
- Front
- Back
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acute bronchitis
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USUALLY VIRAL
Abx do nothing Tx symptoms a few exceptions..... |
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acute bronchitis: influenza
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VACCINATE
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acute bronchitis: B. pertussis
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macrolides,
OR tetracylines, OR TMP/SMX |
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COPD exacerbation: who to treat?
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pts with 3 symp: increased dyspnea, increased sputum volumn, increased purulence (2/3 if purulence)
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Common bugs in COPD?
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S. pneumoniae, H. influ, M. cattarhalis, C. pneumoniae, m. pneumoniae
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Oral therapy for mild-moderate COPD exac?
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amoxicillin,
amoxicillin/clavulanic acid OR DOXY TMP/SMX OR macroclinde, FQ |
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IV therapy (pts with poor outcome) COPD exac?
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Amp/sulbactam
2/3 gen ceph, FQ |
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If p. aeruginosa COPD
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oral FQ
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Time for COPD Tx?
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3-7 days
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pneumonia: CAP pathogens
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s. pneumo, h. influenzae, m. cattarh, m. pneumo, c. pneumo, l. pneumophilia (maybe s. aureus (MRSA) if post-influenza, severe, or necrotizing, or oral anaerobes)
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CAP-outpt therapy: healthy Tx
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macrolide (azithro) OR
doxycyclin |
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CAP-outpt: comorbid, immunosupp, recent Ab exposures Tx
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macroclinde/doxy add cephlo. (for s. pneumo resistance) or
high dose amoxicillin/OR amox&clav |
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CAP inpi non-icu Tx
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3rd gen cephalo + macroclide OR
resp FQ (no CIPRO; does not have reliable action against strep)---- YES, by themselves |
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CAP inpt ICU
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IV!!!!!!
otherwise same as inpt add vanco if MRSA |
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Aspiration pneumonia Tx outpt
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add: clinda, or amox/calv, or moxi for ORAL ANAEROBES
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Depending of where your practicing, what is the most important issue?
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GET IF RIGHT UP FRONT!! May not ALWAYS be pseudomonas.
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CAP duration of Tx
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5 days min, then monitor....
afebrile for 48-72 hours, take off Abx |
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CAP related sign of instability
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fever
leukocytosis heart rate resp rate |
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HAP/HCAP/VAP: bugs
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p. aeruginosa, e. coli, k pneumo, entero bacter spp, serratia, s aureus
2 most common: MRSA, pseudomonas |
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HAP empitic
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START BROAD!!! THEN NARROW.... all three of
anti-psudomon B lactam anti-psudomon FQ/AminoGlycoside (pseudomonas) vanco or linezolid (MRSA) |
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HAP duration of Tx
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14-21 days
8 days if NOT pseudomonas or acinetobacter |
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HAP: not MRSA
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ditch gram (+) coverage
MODIFY REGIMEN!! |
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Stenotrophomonas maltophilia suseptibility
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TMX/SMX (DOC)
TICARCILLIN/CLAV MOXI TIGECYCLINE |
