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23 Cards in this Set

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acute bronchitis
USUALLY VIRAL
Abx do nothing
Tx symptoms
a few exceptions.....
acute bronchitis: influenza
VACCINATE
acute bronchitis: B. pertussis
macrolides,


OR tetracylines, OR TMP/SMX
COPD exacerbation: who to treat?
pts with 3 symp: increased dyspnea, increased sputum volumn, increased purulence (2/3 if purulence)
Common bugs in COPD?
S. pneumoniae, H. influ, M. cattarhalis, C. pneumoniae, m. pneumoniae
Oral therapy for mild-moderate COPD exac?
amoxicillin,
amoxicillin/clavulanic acid OR
DOXY
TMP/SMX OR
macroclinde,
FQ
IV therapy (pts with poor outcome) COPD exac?
Amp/sulbactam
2/3 gen ceph, FQ
If p. aeruginosa COPD
oral FQ
Time for COPD Tx?
3-7 days
pneumonia: CAP pathogens
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)
CAP-outpt therapy: healthy Tx
macrolide (azithro) OR
doxycyclin
CAP-outpt: comorbid, immunosupp, recent Ab exposures Tx
macroclinde/doxy add cephlo. (for s. pneumo resistance) or
high dose amoxicillin/OR amox&clav
CAP inpi non-icu Tx
3rd gen cephalo + macroclide OR
resp FQ (no CIPRO; does not have reliable action against strep)---- YES, by themselves
CAP inpt ICU
IV!!!!!!
otherwise same as inpt
add vanco if MRSA
Aspiration pneumonia Tx outpt
add: clinda, or amox/calv, or moxi for ORAL ANAEROBES
Depending of where your practicing, what is the most important issue?
GET IF RIGHT UP FRONT!! May not ALWAYS be pseudomonas.
CAP duration of Tx
5 days min, then monitor....
afebrile for 48-72 hours, take off Abx
CAP related sign of instability
fever
leukocytosis
heart rate
resp rate
HAP/HCAP/VAP: bugs
p. aeruginosa, e. coli, k pneumo, entero bacter spp, serratia, s aureus
2 most common: MRSA, pseudomonas
HAP empitic
START BROAD!!! THEN NARROW.... all three of
anti-psudomon B lactam
anti-psudomon FQ/AminoGlycoside (pseudomonas)
vanco or linezolid (MRSA)
HAP duration of Tx
14-21 days
8 days if NOT pseudomonas or acinetobacter
HAP: not MRSA
ditch gram (+) coverage

MODIFY REGIMEN!!
Stenotrophomonas maltophilia suseptibility
TMX/SMX (DOC)
TICARCILLIN/CLAV
MOXI
TIGECYCLINE