Pneumoniae respiratory fq levo 750 mg po qd moxi 400

This preview shows page 23 - 26 out of 31 pages.

(>25% of high level macrolide resistant S. Pneumoniae Respiratory FQ Levo 750 mg PO QD Moxi 400 mg PO QD ß-lactam + macrolide or doxy ß-lactam Amox 1g q8h Amox/clav 2g PO q12h Cefpodoxime 200 mg q12h Cefuroxime 500 mg q12h Macrolide Azithromycin z-pack or 500 mg qd x 3D Clarithromycin 500 mg q12h x 5d Doxycycline 100 mg q12h Inpatient Non-ICU Treatment Respiratory FQ Levo 750 mg PO/IV q24h Moxi 400 mg PO/IV q24h ß-lactam + macrolide or doxy *Comorbidities such as CH, lung, liver or renal disease; DM; alcoholism; malignancies; asplenia; immunosuppresing conditions or use of immunosuppressants
Image of page 23

Subscribe to view the full document.

ß-lactam Ceftriaxone 1-2g IV q24h Cefotaxime 1-2g IV q8h Ampicillin/sulbactam 1.5-3g IV q6h Ertapenem 1g IV q24h Macrolide Azithro 500 mg PO/IV q24h Clarithro 500 mg PO q12h x 5d Doxycycline 100 mg PO q12h Inpatient ICU Treatment Options ß-lactam PLUS macrolide or respiratory FQ ß-lactam Ceftriaxone 1-2g IV q24h Cefotaxime 1-2g IV q8h Ampicillin/sulbactam 3g IV q6h Ertapenem 1g IV q24h Macrolide Azithro 500 mg IV q24h Resp FQ Levo 750 mg IV q24h Moxi 400 mg IV q24h Inpatient ICU: special concerns If pseudomonas aeruginosa is a concern: Antipneumococcal, antipseudomonal ß lactam PLUS antipseudomonal FQ or aminoglycoside + azithro or aminoglycoside + antipneumococcal FQ ß-lactams Piperacillin/tazobactam 4.5 g IV q6h Cefepime 2g IV q8h Meropenem 1g IV q8h Antipseudomonal FQ Cipro 400 mg IV q8h Levo 750 mg IV q8h Risk factors: COPD or bronchiectasis (especially those on GCs or immunosuppresants) Penicilin-allergic patients Aztreonam 2g IV q8h PLUS respiratory FQ + aminoglycoside If MRSA is a concern: Vanc 15-20 mg/kg IV q12h Linezolid 600 mg IV/PO q12h Risk Factors: recent influenza-like illness, GC use, necrotizing or cavitary pneumonia, presence of empyema Finer Points Treatment based on accurate diagnosis Differential: CHF, COPD Low rates of resistance to empiric therapy
Image of page 24
If organism is isolated, narrow therapy Causative pathogen not identified ~60% Patient Outcomes Clinical improvement 48-72 hours Cough 8 days Auscuatory crackles 21 days Complete resolution 2+ weeks Chest radiographic abnormalities are slowest to resolve (<12 wks) Viral Pneumonias Influenza, adenovirus, parainfluenza, respiratory syncytial virus, human metapneumovirus Influenza Single-stranded, segmented RNA genome A,B-seasonal epidemics vs C- mild disease Influenza A subtyped based on 2 main surface protein components Hemagglutinin HA or H Neuraminidase NA or N Bind to receptors on surface of respiratory epithelial cells via HA Antigenic drift A and B, antigenic changes in HA Unpredictable, evolutionary -seasonal epidemics Antigenic Shift Human infection with novel influenza A genetically different vs circulating influenza A viruses Symptoms
Image of page 25

Subscribe to view the full document.

Image of page 26
  • Fall '19
  • Tetracycline, UTI, Ceftriaxone

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern

Ask Expert Tutors You can ask 0 bonus questions You can ask 0 questions (0 expire soon) You can ask 0 questions (will expire )
Answers in as fast as 15 minutes