Clinical presentation: Bronchitis
Acute cough for usually less than 3 weeks
Bronchitis Vs Pneumonia: Site of infx
Bronchitis: Inflammation of trachea & lower airways;
Pneumonia: Lung parenchyma
What does urinary antigen test test for?
- Streptococcus pneumonia
- Legionella pneumophilia
Risk factors for drug resistant organisms
Being empirically treated for MRSA or P. aeruginosa
Were previously infected with MRSA or P. aeruginosa in the last 1 year
Were hopsitalised or received parenteral antibiotics in the last 90 days
When to obtain pre-treatment blood and resp gram stain and culture?
In patients managed in the hospital who are:
- Severe CAP
OR
- Have risk factors for drug resistant organisms
Risk stratification using Pneumonia Severity Index (PSI)
Class I & II: outpatient
Class III: short hospitalization or observation
Class IV and V: inpatients
Risk stratification using CURB-65
0 or 1: outpatient
2: inpatient
3-5: inpatient, consider ICU
Criteria for CURB-65
Confusion
Urea > 7 mmol/L
RR ≥ 30 bpm
SBP < 90 or DBP ≤ 60
≥ 65 y/o
Risk stratification for severe CAP
1 major criteria or at least 3 minor criteria
Antibiotics that cover Atypicals
- FQs (except ciprofloxacin)
- Doxycycline
- Macrolides
Organism to cover outpatient, no comorb
Strep pneumoniae
Organism to cover outpatient, with comorb / inpatient, non-severe
Strep pneumoniae, Haemophilus influenzae & Atypicals
Inpatient - consider MRSA/ Pseudomonas risk factors
Which antibiotic is commonly used to cover Burkholderia pseudomallei?
Ceftazidime
Does ceftazidime cover strep pneumo?
No.
When to cover anaerobes?
Radiological exams reveal:
- Lung abscess
OR
- Empyema
Antibiotic to add if standard regimen has no anaerobic activity
IV/PO Metronidazole OR Clindamycin
When to add Adjunctive corticosteroid therapy?
shock refractory to fluid resuscitation and vasopressor support
Treatment duration for CAP
Minimal 5-days; 7 days if suspected/ proven MRSA/ Pseudomonas
Risk factor for high mortality risk
need for ventilatory support due to HAP and septic shock
When to use 2 anti-pseudomonal agents for HAP/VAP?
- a risk factor for antimicrobial resistance (prior IV antibiotic use within 90 d; acute renal replacement therapy prior to VAP onset; isolation of P. aeruginosa in last 1 year)
- hospitalization in a unit where >10% of Pseudomonas isolates are resistant to an agent being considered for monotherapy
- if prevalence of PA is not known but patient at high risk for mortality (include need for ventilatory support due to HAP and septic shock)
Organism to cover for VAP/HAP
Pseudomonas & S. aureus
Treatment duration for VAP/HAP
7 days
Should not escalate antibiotic therapy in the first ______
72 hours
