1. More Antibiotics Tutoring
Alaina Darby

2. CAP

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

4. 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

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

6. Remember this patient? SO is a 55 yo WM who presents with pneumonia symptoms. The following are his relevant lab values: BUN CrCl 75 RR BG 155 (fasting) BP 85/65 HR 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

7. 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 CrCl 75 RR 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

8. 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 CrCl 75 RR 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

9. 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 CrCl 75 RR 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

10. 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

11. 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

12. 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

13. 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

14. 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