NAPLEX - CAP/HAP
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40 Terms
cap sx
- SOB
- fever
- cough
- purulent sputum
- pleuritic chest pain
- rales (crackling noises in lungs)
- tachypnea (inc RR)
- decreased breath sounds
cap bugs
- strep pneumo
- h influenzae
- m pneumoniae
what comorbidities should be checked for before treating cap?
chronic heart, lung, liver, renal dx, DM, alcohol use disorder, malignancy, asplenia
outpatient cap treatment options - healthy, no comorbidities
- amoxicillin
- doxycycline
- macrolide (azithromycin, clarithromycin) if local pneumococcal resistance is <25%
outpatient cap treatment options - with comorbidities
beta lactam + macrolide OR doxycycline
- beta lactam: amox/clav OR cephalosporin (cefuroxime)
- macrolide: azithro / clarithromycin
OR
fluoroquinolone monotherapy
- moxifloxacin, levofloxacin
outpatient cap treatment duration
x5 days
continue until pt is afebrile for 48-72 hrs + pt is clinically stable
outpatient cap treatment
amoxicillin dosing
amoxicillin 1 g PO TID x 5 days
continue until pt is afebrile for 48-72 hrs + pt is clinically stable
outpatient cap treatment
doxycycline dosing
doxycycline 100 mg PO BID x 5 days
continue until pt is afebrile for 48-72 hrs + pt is clinically stable
outpatient cap treatment
azithromycin dosing
azithromycin 500 mg PO on day 1 then
azithromycin 250 mg daily x 4 days OR
azithromycin 500 mg daily x 3 days
outpatient cap treatment
clarithromycin dosing
clarithromycin IR 500 mg PO BID x 5 days
OR
clarithromycin 1 g (2 500 mg ER tablets) once daily x 5 days
continue until pt is afebrile for 48-72 hrs + pt is clinically stable
outpatient cap treatment
moxifloxacin dosing
moxifloxacin 400 mg PO daily x 5 days
continue until pt is afebrile for 48-72 hrs + pt is clinically stable
outpatient cap treatment
levofloxacin dosing
levofloxacin 750 mg PO daily x 5 days
continue until pt is afebrile for 48-72 hrs + pt is clinically stable
inpatient cap treatment options - non severe (admission to general medicine unit)
beta lactam + macrolide OR doxycycline
- beta lactam = ceftriaxone, ceftaroline, amp/sul
OR
respiratory quinolone monotherapy
- quinolone = moxifloxacin, levofloxacin
inpatient cap treatment options - severe (admission to ICU)
beta lactam + macrolide
- beta lactam = ceftriaxone, ceftaroline, amp/sul
- macrolide = azithro / clarithromycin
OR
beta lactam + respiratory quinolone
- quinolone = moxifloxacin, levofloxacin
* do not use quinolone monotherapy *
inpatient cap treatment
ceftriaxone dosing
ceftriaxone 1-2 g once daily x 5 days
2 g is usually for critically ill patients
continue until pt is afebrile for 48-72 hrs + pt is clinically stable
inpatient cap treatment
ceftaroline dosing
ceftaroline 600 mg q12h IV x7 days
continue until pt is afebrile for 48-72 hrs + pt is clinically stable
inpatient cap treatment
amp/sul dosing
amp/sul (unasyn) 3 g q6h IV x 5 days
continue until pt is afebrile for 48-72 hrs + pt is clinically stable
inpatient cap treatment
moxifloxacin dosing
moxifloxacin 400 mg once daily PO/IV x 5 days
continue until pt is afebrile for 48-72 hrs + pt is clinically stable
inpatient cap treatment
levofloxacin dosing
levofloxacin 750 mg daily IV/PO x 5 days
continue until pt is afebrile for 48-72 hrs + pt is clinically stable
MRSA covering agents
- vancomycin
- linezolid
pseudomonas covering agents
- pip/tazo
- cefepime
- ceftazidime
- imi / meropenem
inpatient cap treatment
if hospitalized + use of parenteral abx in past 90 days, what coverage should be added
coverage against BOTH MRSA + PsA
hospital acquired pneumonia (hap)
onset > 48 hrs after hospital admission
hap sx
- SOB
- fever
- cough
- purulent sputum
- pleuritic chest pain
- rales (crackling noises in lungs)
- tachypnea (inc RR)
- decreased breath sounds
hap bugs
- MRSA
- P aeruginosa
- Acinetobacter
- Enterobacter
- E coli
- Klebsiella
risk factors for hap
- systemically active abx in last 90 days
- septic shock at time of pna onset
- vap
hap treatment options
all pts target PsA + MSSA
- cefepime
- pip/tazo
- levofloxacin
if at risk for MRSA, add:
- vancomycin
- linezolid
if at risk for MDR gram (-) pathogens, add another PsA covering agent:
- beta lactams: pip/tazo, cefepime, ceftazidime, imi/meropenem
- quinolones: levo/ciprofloxacin
- aztreonam
- aminoglycosides: tobramycin
hap treatment duration
x7 days
hap treatment
cefepime dosing
cefepime 2 g q8h IV x 7 days
hap treatment
pip/tazo dosing
pip/tazo 4.5 g q6h IV x7 days
hap treatment
levofloxacin dosing
levofloxacin 750 mg q24h PO/IV x7 days
hap treatment
vancomycin dosing
vanco 15-20 mg/kg q8-12h IV x7 days
hap treatment
linezolid dosing
linezolid 600 mg q12h PO/IV x7 days
hap treatment
ceftazidime dosing
ceftazidime 2 g q8h IV x7 days
hap treatment
imipenem dosing
imipenem 500 mg q6h IV x7 days
hap treatment
meropenem dosing
meropenem 1 g q8h IV x7 days
hap treatment
ciprofloxacin dosing
ciprofloxacin 750 mg q12h PO x7 days
OR
ciprofloxacin 400 mg q8h IV x7 days
hap treatment
aztreonam dosing
aztreonam 2 g q8h IV x7 days
hap treatment
tobramycin dosing
tobramycin 5-7 mg/kg once daily x7 days
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