LR II

What organisms are we most concerned about for HAP/VAP?

MRSA, Enterobacterales, Pseudomonas

What antibiotics do we use to treat HAP/VAP in a patient with no MDRO risk factors?

Pip/tazo

Cefepime

Levofloxacin

Merppenem/Imipenem

All patients get empiric coverage for MSSA, Enterobacterales, and Pseudomonas

Which HAP require empiric MRSA coverage?

Which VAP require empiric MRSA coverage?

What antibiotics do we use if a patient requires MRSA coverage?

Vanco (or linezolid)

and

Piptazo (or cefepime or levofloxacin or mero/imipenem)

Which HAP patients require double pseudomonas coverage?

Which VAP patients require double pseudomonas coverage?

What antibiotics do we use if a patient requires double pseudomonas coverage?

Piptazo or cefepime or ceftazidime or Mero/imipenem or Aztreonam

AND

Levo/cipro or aminoglycoside (which one help reem pls) or colisitin (not for staph coverage)

What antibiotics do we use if a patient requires double pseudomonas and MRSA coverage?

Vanco or linezolid

AND

Pip tazo or cefepime or ceftazidime or Mero/imipenem or Aztreonam

AND

Levo/cipro or aminoglycoside (which one help reem pls) or colisitin (not for staph coverage)

How long should patients with HAP/VAP be treated?

7 days

de-escalate when appropriate

What is the primary cause of bronchiolitis? Acute bronchitis?

Both are mostly viral, Broncholitis is mostly RSV

Distinguishing factors between broncholitis and acute bronchitis

• Broncholitis is mostly kids <2 whereas acute bronchitis is mostly adults

• Fever present with broncholitis

How is bronchiolitis typically managed?

Management	Details
Outpatient Management	Hydration, Antipyretics
Inpatient Management	Hydration, Respiratory/Oxygen support, Nasal suctioning
Antibiotics	Should be discouraged (viral cause)
Prophylaxis	Nirsevimab (Beyfortus) – Single IM dose before first RSV season, repeat in high-risk babies
	RSV Vaccines – Given during pregnancy or to adults 75+ / high risk

How is acute bronchitis managed?

Management	Details
Outpatient Management	Hydration, Antipyretics, Antitussives (guaifenesin, dextromethorphan), Beta-2 agonists (if baseline bronchoconstriction)
Inpatient Management	Rare
Antibiotics	Should be discouraged (viral cause)
Prophylaxis	None available

How is whooping cough managed?

Azithromycin x 5 days

or

Erythro x 14d

Clarithro x 7d

TMP/SMZ x 14d

What are the common organisms that cause AECB?

Haomophilus influenzae
Strep pneumoniae
Moraxella catarrhalis
Pseudomonas

For ACEB, do not offer abx to

One cardinal symtpom and not requiring hospitalization

Cardinal sx:
Increased dyspnea
Increased sputum volume
Increased sputum purulence

For ACEB, DO offer abx to

3 cardinal sx
Sputum purulence + one other
Mechanical ventilation

Cardinal sx:
Increased dyspnea
Increased sputum volume
Increased sputum purulence

Which patients with AECB should be treated with an anti-pseudomonal agent?

• Pseudomonas colonization

• Culture for pseudomonas in 12 months

• Hospitalization or abx use in 3 months

• Concominant bronchiectasis

Which agent(s) do we use for AECB needing pseudomonas coverage?

IV/PO: Levo or Cipro
IV: Pip/tazo, cefepime