What is the most common organism for CAP?
streptococcus pneumoniae
what are the causative organisms for CAP
-streptococcus pneumoniae
-atypical bacteria (mycoplasma pneumoniae): older and young adults
-viruses (RSV, influenza)
smoker type of aquired CAP
H. influenzae
Cystic fibrosis acquired CAP
pseudomonas aerguinosa
immunocompromised CAP
pneumocystitis carini
first line of treatment for CAP healthy adults
amoxicillin (PCN), doxycycline, azithromycin
what to give second if first line tx for pneumonia did not work?
Levaquin (fluoroquinolone)
treatment for M.Pneumoniae in pediatric patient
macrolide, azithromycin, erythromycin
Treatment of CAP in pregnancy
macrolide, PCN, cephalosporin, erythromycin
-AVOID tetracycline
If someone has been treated with antibiotic for CAP in last 90 days, what class of
medication would be best
floxacin (fluoroquinolone)
chlamydial pneumonia in infant
erythromycin 12.5mg/kg PO QID x 14 days
broad spectrum
active against wide variety of microbes
-gram + cocci and gram - bacilli
narrow spectrum
active against only a few species of specific microorganisms
- gram + cocci, gram - bacilli, gram - aerobes, mycobacterium TB
empiric antibiotics
ciprofloxacin, TMP/SMZ, amoxicillin
-severe infections that may need tx prior to knowing test results
-tx is based on eval and knowledge of microbes that are most likely causing the infection
c. diff associated diarrhea
STOP prior abx and start vancomycin or fidaxomicin
drug class known for all drugs in class to promote c. diff
bacteriostatic inhibitors
what class of medications has a cross sensitivity to PCN
cephalosproins
Is PCN safe in pregnancy
there is no second or third trimester fetal risk
no controlled studies
, cephalosporins
do not take if allergic to pcn. Interacts with alcohol, clotting factors, vitamin K. Increased risk of
c diff so check stools
cephalosporin safe in pregnancy?
yes
tetracycline
discoloration of teeth, avoid <8 yrs. avoid prolonged sun exposure. risk for c diff, renal/hepatic
toxicity
do not take with calcium, milk, iron, mag containing laxative, and most antacids. N/V/D. Rxns
can decrease if taken with meals
tetracycline safe in pregnancy
fetal harm- suppression of growth of long bones
macrolides
can cause QT prolongation risk for torsades de pointes. n/v/d
aminoglycosides
serious toxicity to inner ear (HA, nausea, dizzy, tinnitus, vertigo), toxic to kidneys
sulfanomides
-drink 8-10 glasses of water to reduce risk of crystalluria
-photosensitive use sunblock
-CBC, CD4 if HIV
-renal adjustment 50% if CR clearance 15-30
-birth defects 1st trimester, near term is kernicterus
gentamicin
renal toxic, need adjustments
tinea capitis (ringworm)
oral griseofulvin 8-10 weeks
-oral terbinafine taken 2-4 weeks may be more effective
aspergillosis treatment
voriconazole
which anthelmintic drugs carry risk for hypotension with patients on antihypertensives?
ivermectin and moxidectin
which anthelmintic drugs cause bone marrow suppression and liver impairment?
albendazole and mebendazole
which anthelmintic drug is safe to give without baseline information?
pyrantel pamoate
which anthelmintic drug is safe in pregnancy
mebendazole, albendazole, and pyrantel pamoate in second and third trimester are safe, but not
in first trimester. Do not recommend ivermectin and diethylcarbamazine for pregnancy
risk for didanosine
pancreatitis
risk with saquinavir
heart rhythm problems (PR and QT interval prolongation)
PR interval impacts use of which HIV drugs
protease inhibitors
how to measure success with antiretroviral therapy for HIV
streptococcus pneumoniae
what are the causative organisms for CAP
-streptococcus pneumoniae
-atypical bacteria (mycoplasma pneumoniae): older and young adults
-viruses (RSV, influenza)
smoker type of aquired CAP
H. influenzae
Cystic fibrosis acquired CAP
pseudomonas aerguinosa
immunocompromised CAP
pneumocystitis carini
first line of treatment for CAP healthy adults
amoxicillin (PCN), doxycycline, azithromycin
what to give second if first line tx for pneumonia did not work?
Levaquin (fluoroquinolone)
treatment for M.Pneumoniae in pediatric patient
macrolide, azithromycin, erythromycin
Treatment of CAP in pregnancy
macrolide, PCN, cephalosporin, erythromycin
-AVOID tetracycline
If someone has been treated with antibiotic for CAP in last 90 days, what class of
medication would be best
floxacin (fluoroquinolone)
chlamydial pneumonia in infant
erythromycin 12.5mg/kg PO QID x 14 days
broad spectrum
active against wide variety of microbes
-gram + cocci and gram - bacilli
narrow spectrum
active against only a few species of specific microorganisms
- gram + cocci, gram - bacilli, gram - aerobes, mycobacterium TB
empiric antibiotics
ciprofloxacin, TMP/SMZ, amoxicillin
-severe infections that may need tx prior to knowing test results
-tx is based on eval and knowledge of microbes that are most likely causing the infection
c. diff associated diarrhea
STOP prior abx and start vancomycin or fidaxomicin
drug class known for all drugs in class to promote c. diff
bacteriostatic inhibitors
what class of medications has a cross sensitivity to PCN
cephalosproins
Is PCN safe in pregnancy
there is no second or third trimester fetal risk
no controlled studies
, cephalosporins
do not take if allergic to pcn. Interacts with alcohol, clotting factors, vitamin K. Increased risk of
c diff so check stools
cephalosporin safe in pregnancy?
yes
tetracycline
discoloration of teeth, avoid <8 yrs. avoid prolonged sun exposure. risk for c diff, renal/hepatic
toxicity
do not take with calcium, milk, iron, mag containing laxative, and most antacids. N/V/D. Rxns
can decrease if taken with meals
tetracycline safe in pregnancy
fetal harm- suppression of growth of long bones
macrolides
can cause QT prolongation risk for torsades de pointes. n/v/d
aminoglycosides
serious toxicity to inner ear (HA, nausea, dizzy, tinnitus, vertigo), toxic to kidneys
sulfanomides
-drink 8-10 glasses of water to reduce risk of crystalluria
-photosensitive use sunblock
-CBC, CD4 if HIV
-renal adjustment 50% if CR clearance 15-30
-birth defects 1st trimester, near term is kernicterus
gentamicin
renal toxic, need adjustments
tinea capitis (ringworm)
oral griseofulvin 8-10 weeks
-oral terbinafine taken 2-4 weeks may be more effective
aspergillosis treatment
voriconazole
which anthelmintic drugs carry risk for hypotension with patients on antihypertensives?
ivermectin and moxidectin
which anthelmintic drugs cause bone marrow suppression and liver impairment?
albendazole and mebendazole
which anthelmintic drug is safe to give without baseline information?
pyrantel pamoate
which anthelmintic drug is safe in pregnancy
mebendazole, albendazole, and pyrantel pamoate in second and third trimester are safe, but not
in first trimester. Do not recommend ivermectin and diethylcarbamazine for pregnancy
risk for didanosine
pancreatitis
risk with saquinavir
heart rhythm problems (PR and QT interval prolongation)
PR interval impacts use of which HIV drugs
protease inhibitors
how to measure success with antiretroviral therapy for HIV
