More Antibiotics Tutoring Alaina Darby

CAP

Remember this patient? SO is a 55 yo WM who presents with pneumonia symptoms. The following are his relevant lab values: BUN 15 CrCl 75 RR 22 BG 155 (fasting) BP 85/65 HR 105 How should the patient be treated if the last time he had antibiotics was 5 months ago? A Azithromycin + cephalexin Doxycycline Azithromycin Doxycycline + cephalexin

Outpatient Inpatient (non-ICU) Inpatient (ICU) Healthy with no antibiotics in the last 3 months Macrolide Doxycycline Comorbidities or antibiotics in the last 3 months Respiratory FQ B-lactam + macrolide Inpatient (non-ICU) Inpatient (ICU) B-lactam + respiratory FQ

Special considerations Pseudomonas Use levofloxacin as the FQ Add an AMG MRSA Vancomycin S. pneumonia Any B-lactam that works (penicillins, cephalosporins…)

Remember this patient? SO is a 55 yo WM who presents with pneumonia symptoms. The following are his relevant lab values: BUN 15 CrCl 75 RR 22 BG 155 (fasting) BP 85/65 HR 105 When should antibiotics be administered? A While in the ED Within 1 hour of admission Within 4 hours of arrival When the cultures come back

SO is a 55 yo WM who presents with pneumonia SO is a 55 yo WM who presents with pneumonia. IV antibiotics were administered and SO’s lab values are now: BUN 15 CrCl 75 RR 22 BG 155 (fasting) BP 100/75 HR 105 Temp 38 C (38.4 C upon admission) What should you do first? Discharge them Administer more fluids Order another CXR Switch them to PO meds D

SO is a 55 yo WM who presents with pneumonia SO is a 55 yo WM who presents with pneumonia. IV antibiotics were administered and SO’s lab values are now: BUN 15 CrCl 75 RR 22 BG 155 (fasting) BP 100/75 HR 105 Temp 38 C (38.4 C upon admission 2 days ago) What should you do? Discontinue antibiotics Continue antibiotics for 3 days Continue antibiotics for 5 days Continue antibiotics (time period uncertain) D

SO is a 55 yo WM who presents with pneumonia 5 days ago, where he was given antibiotics in the ED. He is on PO antibiotics now: BUN 15 CrCl 75 RR 20 BG 125 (fasting) BP 120/80 HR 70 Temp 37.5 C (37.7 C at 72 hours ago) What would be appropriate? Discontinue antibiotics Continue antibiotics for 3 days Continue antibiotics for 5 days Continue antibiotics (time period uncertain) A

ID is a 32 yo WM who comes to you asking about what vaccines his mother and father should get. His father is 66 yo and his mother is 62 yo, both without any chronic illnesses. Both have already received PPSV23 two years ago. What should you tell him? His mother should receive the PCV13 now, since she is over 60 His mother should receive the PCV13 now, since it has been over a year since PPSV23 His mother should receive the PCV13 in 3 years when she is 65 His mother should not receive the PCV13, since she has no comorbid conditions C

ID is a 32 yo WM who comes to you asking about what vaccines his mother and father should get. His father is 66 yo and his mother is 62 yo, both without any chronic illnesses. Both have already received PPSV23 two years ago. What should you tell him? His father should receive the PPSV23 now, since she is over 60 His father should receive the PCV13 now, since it has been over a year since PPSV23 His father should receive another dose of PPSV23, since it has been over a year His father should not receive the PCV13, since she has no comorbid conditions B

ID is a 32 yo WM who comes to you asking about what vaccines his mother and father should get. His father is 66 yo and his mother is 62 yo, both without any chronic illnesses. Both have already received PPSV23 two years ago. After asking more questions, you learn that ID has COPD. Should you recommend anything for him? PCV13 first followed by PPSV23 in one year PPSV23 first followed by PCV13 in one year PCV13 now followed by PPSV23 when he turns 65 PPSV23 now followed by PCV13 when he turns 65 A

Which treatment option reduces the risk of pneumonia in COPD patients? Administration of oxygen Discontinuation of fluticasone Antipyretics for high fever Use of inhaled B-2 agonists B

Which would not be true for a course of levofloxacin? Should be taken at least 2 hours before antacids like Tums Should be administered at least 6 hours after drinking milk 750 mg for 5 days is more effective than 500 mg per day for 10 days Sucralafate can reduce serum concentration up to 90% C