Today we had an academic half day session on pneumonia, presented by Glen Brown.
I thought that the case based presentation was very effective to bringing us through the thought process for pneumonia management. The interactive portion allowed many opportunities for us to speak out and engage in the discussion.
FMI:
- SPACE: Serratia, Pseudomonas, Acinetobacter, Citrobacter, Enterobacter–> gram negative requiring extended spectrum
- ESBL- enzyme hydrolyze beta lactamase–> DOC: carbapeneum, avoid using carbapenem in other cases when possible
- ESBL=ESBLs are capable of efficiently hydrolyzing penicillins, narrow spectrum cephalosporins, many extended-spectrum cephalosporins, the oxyimino group containing cephalosporins (cefotaxime, ceftazidime), and monobactams (aztreonam).
- linezolid: bone marrow suppression
- 2 agents that is active against one organism is not more effective than 1 agent that is active ( not synergistic)
- sputum gram stain results can come back as early as 2 hours
- sputum cultures can take 48 hours to get the results of
- CURB-65 ( confusion, uremic: CrCl, RR greater than 30, SBP less than 90, DBP less than 60, age 65 or older)
- top 4 org in order of prevalence: strep pneumo, moroxella catarrlis, atypical- mycoplasma/clamidyia, h. influ
- moxi: broad spectrum ; work for all four org
- azithro: increase resistance to s. pneumo; work for all four org
- clarithro: many more drug interactions than azithro, BID dosing compare to azithro; better pseudomonas coverage
- amox/clav: doesn’t cover atypicals, cover all other org
- cefuroxime: doesn’t cover atypicals, cover all other org
- cefuroxime + clarithro–> fill in gap of non-atypical coverage that cefuroxime misses
- doxcycline: doesn’t cover atypicals
- IV vs oral: n/v, admitting pt?, drug bioavailability, GI absorption?
- in hospital doesn’t always require IV
- if sensitive to Pen G–> can switch if hospitalized–> narrow spectrum used when ever possible
- duration: once patient is afebrile for at least 48 hours and stable, WBC not always normal, but should be decreasing// no define number of days–> depends on how the patient responds
- chest x ray will take approx 6 weeks to clear
- severity of pneumonia affects: antibiotic specturm, antibiotic dose–> NOT duration
- single dose of antibiotic pre/post op doesn’t count as a risk factor
- 8 day therapy is just as good as 14 days
- if pt has MRSA–> don’t tx unless pathogen is identified UNLESS they are high risk downtown east side pt
- aspiration –> antibiotic needed if pt has altered GI motility or respiratory problem–> sputum should be cultured
Pack year is a term used to describe the number of cigarettes a person has smoked over time. One pack year is defined as 20 manufactured cigarettes (one pack) smoked per day for one year.
Example:
I smoked 1 1/2 packs per day for 26 years, which equals 39 pack years:
- 1 pack per day x 26 years = 26 pack years
1/2 pack per day x 26 years = 13 pack years
26 pack years + 13 pack years = 39 pack years
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