Morning Report: 3/20/2015

Dr. Grock presents today’s Morning Report!

 

Pulmonary Infections

 

CAP

  • If no abx in last 3 mo and healthy: A Macrolide (2nd line Doxy)
  • If chronic heart, lung, liver, renal disease, DM, ETOH, Ca, Asplenia, Immunosuppressed, or abx use in last 3 months: Resp fluoroquinolone, B-lactam + Macrolide
  • If inpt: Resp Fluoroquinolone, B-lactam + Macrolide
  • If ICU: B-lactam + azithro/resp fluoroquinolone. If Pen allergic: aztreonam/fluoro.
  • If CA-MRSA concern: add vanco/linezolid
  • If Pseudomonas concern: zosyn/cefepime/imipenem/meropenum + cipro/levo OR aminoglycoside and azithro OR aminoglycoside and antipneumococcal fluoro.
  • Blood cultures?
  • Admit? Curb-65, PSI, clinical judgement

 

HCAP

  • (hosp for >2 days in last 90 days, NH, home infusion therapy, HD, home wound care)
  • Cefepime/ceftazadime OR imipenem/meropenem OR zosyn AND cipro/levo OR gent AND vanco/linezolid
  • Azithro?
  • Admit All? (risk factors: Abx < 90 days, recent hosp >5 days, poor functional status, immunosuppressive dx and/or therapy. If > 2 “high risk”. If < 2 “low risk”. Low risk group = 50% of patients, 93% fine with CAP guidelines.)


PNA in AIDS

  • AIDS: add Bactrim/azithro. ABG: PaO2<70, hypoxia on O2 sat, or A-a gradient >35 give steroids

 

Lung Abscess

  • Clinda (2 studies show better than pens) with vanco/linezolid. Usually polymicrobial. Per Tintinalli’s add a cephalosporin/clinda. Flagyl sucks. Abx 80-90% effective.

 

References

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital

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1 comment for “Morning Report: 3/20/2015

  1. Ian deSouza
    March 20, 2015 at 11:27 am

    A chart would be a nice way to present all of this Grock. Here is a more current review:

    N Engl J Med 2014;371:1619-28. DOI: 10.1056/NEJMra1312885

    For uncomplicated CAP, ID specialists have been discouraging the use of azithromycin due to its unnecessarily broad coverage and overuse and development of pneumococcal resistance in some populations. One should strongly consider doxycycline.

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