Currently of s pneumoniae are somewhat penicillin

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Currently, about 20-40% of S. pneumoniae are somewhat penicillin-resistant. Most of these strains are also resistant to macrolides but remain susceptible to quinolones. Because the degree of penicillin-resistance is low, the blood levels achieved by intravenous beta-lactams are adequate for treatment and relatively well, younger, outpatients can be treated safely with a macrolide. 5. Prevention of pneumonia Influenza immunization should be given annually, and pneumococcal immunization once, to elderly patients and those with heart, lung, or metabolic diseases. 6. Nosocomial pneumonia The pathogenesis has been noted above. In particular, debilitated hospitalized patients are at considerable risk for pneumonia, especially if they have been intubated, had abdominal surgery, or are very elderly. Loss of epithelial fibronectin leads to colonization of the nasopharynx by enteric gram-negatives (including Pseudomonas aeruginosa in patients in the ICU). When these organisms are aspirated by patients whose defense mechanisms (gag reflex, mucociliary elevator, alveolar macrophages) are diminished , pneumonia results(see slide titled Causes of Pneumonia). The main pathogens are gram-negative enterics (in > 50%), and sometimes S. aureus and S. pneumoniae. A broad-spectrum beta-lactam (penicillin/penicillinase inhibitor; cephalosporin; carbapenem) is a commonly chosen treatment. An aminoglycoside should be added for patients at high risk of P. aeruginosa infection (e.g. in the ICU).
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  • Fall '10
  • JoyStewart
  • Anatomy, community-acquired pneumonia

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