Charles Krasner, M.D. University of NV, Reno School of Medicine Sierra NV Veterans Affairs Medical Center

Size: px
Start display at page:

Download "Charles Krasner, M.D. University of NV, Reno School of Medicine Sierra NV Veterans Affairs Medical Center"

Transcription

1 Charles Krasner, M.D. University of NV, Reno School of Medicine Sierra NV Veterans Affairs Medical Center

2 Kathy Peters is a 63 y.o. patient that presents to your urgent care office today with a history of coughing and wheezing for the past 5 days. Originally, she thought she was getting a cold; however, her symptoms have been getting worse, and she states she has never felt this "wiped out" from a cold. She is here to see you today because she feels like she has become more short of breath over the past 24 hours.

3 She tells you that she started feeling sick approximately 5 days ago. It started with a dry cough; however, over the past couple days she has expectorated some clear, and more recently, thicker rust-colored, mucous. She denies frank blood in her sputum. She notices some wheezing after coughing spells. This morning, Kathy woke up in a "coughing fit" and she said she felt some sharp pain in her chest. She rates the pain a 5/10 when it occurs. Kathy has felt feverish over the past few days; she sometimes gets the "chills." Her highest temperature was 102 degrees PMH: hypertension Habits: smoker for 30 years

4 BP: 110/80, HR: 96, RR: 26, T: 101.6, SpO2: 94% on room air Physical exam: fatigued appearing, congested cough Wheezing and rhonchi right lower chest with expiration

5 As you consider all of her presenting symptoms and history you begin to think that the most likely choice out of your differential diagnosis list is: a. Asthma b. Chronic Bronchitis c. Nosocomial Pneumonia d. Community-Acquired Pneumonia (CAP)

6 Candida albicans Staph aureus Strep pneumonia (pneumococcus) Pseudomonas aeruginosa Mycoplasma pneumonia

7 Chest radiography Blood cultures Arterial blood gases Sputum cultures

8

9 a. M. pneumoniae b. S. Pneumoniae c. C. pneumoniae d. A virus e. Legionella

10 The CURB-65 scale is a simple test to determine pneumonia severity, but it is not a substitute for clinical judgment. Clinicians should assign 1 point for each criteria met by the patient. C onfusion Blood U rea Nitrogen (BUN) >20 mg/dl R R >/= 30 B P (systolic <90 mmhg or diastolic </= 60 mmhg) >/= 65 y.o. If the individual scores 0-1 points, outpatient treatment is appropriate. 2 points indicates hospitalization and inpatient treatment. Greater than or equal to 3 points warrants inpatient treatment in the ICU.

11 The most appropriate antimicrobial for Kathy: A macrolide (azithromycin) OR doxycycline Combination therapy with a macrolide AND doxycycline Combination therapy with a beta-lactam (high dose amoxicillin, Augmentin) AND doxycycline A respiratory fluoroquinolone (levofloxacin, moxifloxacin) If Kathy had taken antibiotics in the last 3 months, ciprofloxacin would be an appropriate choice. True False

12 Why classify pneumonia? Critical difference between these two types as different organisms can be responsible Pneumonia treatment is almost always initially empiric, therefore knowledge of the likely pathogens is essential in selecting antibiotic regimen

13 Pneumonia acquired outside the hospital in the immunocompetent host Often have comorbities that make them susceptible to more severe disease and need for hospitalization - CHF, diabetes, COPD, renal insufficiency, stroke

14 It s Strep pneumoniae (pneumococcus) till proven otherwisefrom mild to severe cases, it s the # 1 cause of CAP. Starts with shaking chills and rusty sputum

15 Typical (seen on gram stain) Haemophilus influenza Moraxella catarrhalis Atypical (not seen)- diagnosed by serology Mycoplasma pna Chlamydia pna Legionella pna Viruses

16

17

18

19 Young healthy people, mild disease- Mycoplasma pneumoniae Young healthy people with severe disease- Strep pneumoniae Smokers- Strep pneumoniae, Haemophilus influenza, Moraxella catarrhalis

20 Empiric treatment must always cover possibility of S. pneumonia: Active against: Strep? Atypicals? Example Penicillin Yes No Augmentin Cephalosporin Yes No ceftriaxone Macrolides Yes (+/-) Yes Z-pak Quinolones Yes Yes Levoquin Doxycycline Yes Yes Doxycycline

21 Healthy outpatient, no prior antibiotic use: azithromycin, doxycycline for mild pneumonia Outpatient mild-moderate infection, comorbities, prior Z- pak: Levofloxacin (generic) Inpatient Med Ward azithromycin and ceftriaxone iv, transition to oral levofloxacin ICU admit ceftriaxone and azithromycin- consider adding Vancomycin if cavities on CXR;, but follow cultures to quickly adjust meds to micro lab results Watch for empyema/exudative effusion as complication of pneumococcus if patient remains febrile. May need chest tube

22

Community Acquired Pneumonia. Abdullah Alharbi, MD, FCCP

Community Acquired Pneumonia. Abdullah Alharbi, MD, FCCP Community Acquired Pneumonia Abdullah Alharbi, MD, FCCP A 68 y/ male presented to the ED with SOB and productive coughing for 2 days. Reports poor oral intake since onset due to nausea and intermittent

More information

KAISER PERMANENTE OHIO COMMUNITY ACQUIRED PNEUMONIA

KAISER PERMANENTE OHIO COMMUNITY ACQUIRED PNEUMONIA KAISER PERMANENTE OHIO COMMUNITY ACQUIRED PNEUMONIA Methodology: Expert opinion Issue Date: 8-97 Champion: Pulmonary Medicine Most Recent Update: 6-08, 7-10, 7-12 Key Stakeholders: Pulmonary Medicine,

More information

WORKSHOP. The Multiple Facets of CAP. Community acquired pneumonia (CAP) continues. Jennifer s Situation

WORKSHOP. The Multiple Facets of CAP. Community acquired pneumonia (CAP) continues. Jennifer s Situation Practical Pointers pointers For for Your your Practice practice The Multiple Facets of CAP Dr. George Fox, MD, MSc, FRCPC, FCCP Community acquired pneumonia (CAP) continues to be a significant health burden

More information

Pneumonia Community-Acquired Healthcare-Associated

Pneumonia Community-Acquired Healthcare-Associated Pneumonia Community-Acquired Healthcare-Associated Edwin Yu Clin Infect Dis 2007;44(S2):27-72 Am J Respir Crit Care Med 2005; 171:388-416 IDSA / ATS Guidelines Microbiology Principles and Practice of Infectious

More information

The McMaster at night Pediatric Curriculum

The McMaster at night Pediatric Curriculum The McMaster at night Pediatric Curriculum Community Acquired Pneumonia Based on CPS Practice Point Pneumonia in healthy Canadian children and youth and the British Thoracic Society Guidelines on CAP Objectives

More information

Community-Acquired Pneumonia OBSOLETE 2

Community-Acquired Pneumonia OBSOLETE 2 Community-Acquired Pneumonia OBSOLETE 2 Clinical practice guidelines serve as an educational reference, and do not supersede the clinical judgment of the treating physician with respect to appropriate

More information

CAP, HCAP, HAP, VAP. 1. In 1898, William Osler described community-acquired pneumonia as:

CAP, HCAP, HAP, VAP. 1. In 1898, William Osler described community-acquired pneumonia as: 1. In 1898, William Osler described community-acquired pneumonia as: Brad Sharpe, M.D. Professor of Clinical Medicine Department of Medicine UCSF sharpeb@medicine.ucsf.edu I have no relevant financial

More information

UPDATE IN HOSPITAL MEDICINE

UPDATE IN HOSPITAL MEDICINE UPDATE IN HOSPITAL MEDICINE FLORIDA CHAPTER ACP MEETING 2016 Himangi Kaushal, M.D., F.A.C.P. Program Director Memorial Healthcare System Internal Medicine Residency DISCLOSURES None OBJECTIVES Review some

More information

Pneumonia. Dr. Rami M Adil Al-Hayali Assistant professor in medicine

Pneumonia. Dr. Rami M Adil Al-Hayali Assistant professor in medicine Pneumonia Dr. Rami M Adil Al-Hayali Assistant professor in medicine Definition Pneumonia is an acute respiratory illness caused by an infection of the lung parenchyma, associated with recently developed

More information

Community-acquired pneumonia in adults

Community-acquired pneumonia in adults Prim Care Clin Office Pract 30 (2003) 155 171 Community-acquired pneumonia in adults Julio A. Ramirez, MD a,b, * a Department of Medicine, University of Louisville School of Medicine, 512 S. Hancock Street,

More information

Community-Acquired Pneumonia. Lisa G. Winston, MD University of California, San Francisco San Francisco General Hospital. Nothing to disclose.

Community-Acquired Pneumonia. Lisa G. Winston, MD University of California, San Francisco San Francisco General Hospital. Nothing to disclose. Community-Acquired Pneumonia Lisa G. Winston, MD University of California, San Francisco San Francisco General Hospital Nothing to disclose. Community-Acquired Pneumonia Talk will focus on adults Guideline

More information

PNEUMONIA. Patient Case: Chief Complaint: I have been short of breath and have been coughing up rust-colored phlegm for the past 3 days.

PNEUMONIA. Patient Case: Chief Complaint: I have been short of breath and have been coughing up rust-colored phlegm for the past 3 days. PNEUMONIA Relevant Guidelines: 2008 IDSA CAP guidelines: http://www.idsociety.org/guidelines/patient_care/idsa_practice_guidelines/infections_by_org an_system/lower/upper_respiratory/community-acquired_pneumonia_(cap)/

More information

Fraser Health pandemic preparedness

Fraser Health pandemic preparedness Fraser Health pandemic preparedness DRAFT Last revised: April 2006 General Management of Patients in Acute Care Facilities During an Influenza Pandemic 1. OVERVIEW GENERAL MANAGEMENT OF PATIENTS IN ACUTE

More information

Upper...and Lower Respiratory Tract Infections

Upper...and Lower Respiratory Tract Infections Upper...and Lower Respiratory Tract Infections Robin Jump, MD, PhD Cleveland Geriatric Research Education and Clinical Center (GRECC) Louis Stokes Cleveland VA Medical Center Case Western Reserve University

More information

an inflammation of the bronchial tubes

an inflammation of the bronchial tubes BRONCHITIS DEFINITION Bronchitis is an inflammation of the bronchial tubes (or bronchi), which are the air passages that extend from the trachea into the small airways and alveoli. Triggers may be infectious

More information

How do we define pneumonia?

How do we define pneumonia? Robert L. Keith MD FCCP Associate Professor of Medicine Division of Pulmonary Sciences & Critical Care Medicine Denver VA Medical Center University of Colorado Denver How do we define pneumonia? Fever

More information

COPD Treatable. Preventable.

COPD Treatable. Preventable. My COPD Action Plan Patient s Copy (Patient s Name) Date Canadian Respiratory COPD Treatable. Preventable. This is to tell me how I will take care of myself when I have a COPD flare-up. My goals are My

More information

URIs and Pneumonia. Elena Bissell, MD 10/16/2013

URIs and Pneumonia. Elena Bissell, MD 10/16/2013 URIs and Pneumonia Elena Bissell, MD 10/16/2013 Objectives Recognize and treat community acquired PNA in children/adults Discern between inpatient and outpatient treatment of PNA Recognize special populations/cases

More information

Antimicrobial Stewardship in Community Acquired Pneumonia

Antimicrobial Stewardship in Community Acquired Pneumonia Antimicrobial Stewardship in Community Acquired Pneumonia Medicine Review Course 2018 Dr Lee Tau Hong Consultant Department of Infectious Diseases National Centre for Infectious Diseases Scope 1. Diagnosis

More information

Objectives. Pneumonia. Pneumonia. Epidemiology. Prevalence 1/7/2012. Community-Acquired Pneumonia in infants and children

Objectives. Pneumonia. Pneumonia. Epidemiology. Prevalence 1/7/2012. Community-Acquired Pneumonia in infants and children Objectives Community-Acquired in infants and children Review of Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America - 2011 Sabah Charania,

More information

Pneumonia: The Forgotten Killer

Pneumonia: The Forgotten Killer Pneumonia: The Forgotten Killer David Glenn Weismiller, MD, ScM, FAAFP Department of Family and Community Medicine University of Nevada, Las Vegas School of Medicine Disclosure Statement It is the policy

More information

Respiratory Infections

Respiratory Infections Respiratory Infections NISHANT PRASAD, MD THE DR. JAMES J. RAHAL, JR. DIVISION OF INFECTIOUS DISEASES NEWYORK-PRESBYTERIAN QUEENS Disclosures Stockholder: Contrafect Corp., Bristol-Myers Squibb Co Research

More information

POLICY FOR TREATMENT OF LOWER RESPIRATORY TRACT INFECTIONS

POLICY FOR TREATMENT OF LOWER RESPIRATORY TRACT INFECTIONS POLICY F TREATMENT OF LOWER RESPIRATY TRACT INFECTIONS Written by: Dr M Milupi, Consultant Microbiologist Date: June 2018 Approved by: The Drugs & Therapeutics Committee Date: July 2018 Implementation

More information

Aspiration pneumonia in older people

Aspiration pneumonia in older people Aspiration pneumonia in older people Ayman Morish, M.D. Internal medicine, Critical care Medicine and Geriatrics Fellow. Contents Epidemiology Causes of aspiration pneumonia Issues of older age Management

More information

Pneumonia Severity Scores:

Pneumonia Severity Scores: Pneumonia Severity Scores: Are they Accurate Predictors of Mortality? JILL McEWEN, MD FRCPC Clinical Professor Department of Emergency Medicine University of British Columbia Vancouver, BC Canada President,

More information

PULMONARY EMERGENCIES

PULMONARY EMERGENCIES EMERGENCIES I. Pneumonia A. Bacterial Pneumonia (most common cause of a focal infiltrate) 1. Epidemiology a. Accounts for up to 10% of hospital admissions in the U.S. b. Most pneumonias are the result

More information

Community Acquired Pneumonia

Community Acquired Pneumonia April 2014 References: 1. Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, Kaplan SL Mace SE, McCracken Jr. GH, Moor MR, St. Peter SD, Stockwell JA, and Swanson JT. The Management of

More information

Bradley A. Sharpe, M.D. Associate Professor Medicine Department of Medicine UCSF

Bradley A. Sharpe, M.D. Associate Professor Medicine Department of Medicine UCSF Maximizing Care for Community- Acquired Pneumonia Bradley A. Sharpe, M.D. Associate Professor Medicine Department of Medicine UCSF sharpeb@medicine.ucsf.edu 1. In 1898, William Osler described community-acquired

More information

Community Acquired Pneumonia-Adults Clinical Practice Guideline MedStar Health

Community Acquired Pneumonia-Adults Clinical Practice Guideline MedStar Health Community Acquired Pneumonia-Adults Clinical Practice Guideline MedStar Health These guidelines are provided to assist physicians and other clinicians in making decisions regarding the care of their patients.

More information

Pneumonia. Definition of pneumonia Infection of the lung parenchyma Usually bacterial

Pneumonia. Definition of pneumonia Infection of the lung parenchyma Usually bacterial Pneumonia Definition of pneumonia Infection of the lung parenchyma Usually bacterial Epidemiology of pneumonia Commonest infectious cause of death in the UK and USA Incidence - 5-11 per 1000 per year Worse

More information

Choosing an appropriate antimicrobial agent. 3) the spectrum of potential pathogens

Choosing an appropriate antimicrobial agent. 3) the spectrum of potential pathogens Choosing an appropriate antimicrobial agent Consider: 1) the host 2) the site of infection 3) the spectrum of potential pathogens 4) the likelihood that these pathogens are resistant to antimicrobial agents

More information

CARE OF THE ADULT PNEUMONIA PATIENT

CARE OF THE ADULT PNEUMONIA PATIENT Care Guideline CARE OF THE ADULT PNEUMONIA PATIENT Target Audience: The target audience for this Care Guideline is all MultiCare providers and staff, including those associated with our clinically integrated

More information

The Importance of Appropriate Treatment of Chronic Bronchitis

The Importance of Appropriate Treatment of Chronic Bronchitis ...CLINICIAN INTERVIEW... The Importance of Appropriate Treatment of Chronic Bronchitis An interview with Antonio Anzueto, MD, Associate Professor of Medicine, University of Texas Health Science Center,

More information

11/19/2012. The spectrum of pulmonary diseases in HIV-infected persons is broad.

11/19/2012. The spectrum of pulmonary diseases in HIV-infected persons is broad. The spectrum of pulmonary diseases in HIV-infected persons is broad. HIV-associated Opportunistic infections Neoplasms Miscellaneous conditions Non HIV-associated Antiretroviral therapy (ART)-associated

More information

Community acquired pneumonia

Community acquired pneumonia Community acquired pneumonia definition Symptoms of an acute LRTI New focal signs on chest examination At least one systemic feature New radiographic shadow Defination{Crofton} IT IS A SYNDROME CAUSED

More information

Catherine Casey S. Jones,

Catherine Casey S. Jones, Community Acquired Pneumonia Catherine Casey S. Jones, PhD, RN, ANP-C, AE-C Catherine Casey S. Jones, PhD, RN, ANP-C, AE-C Texas Pulmonary & Critical Care Consultants, PA & Adjunct Professor at Texas Woman

More information

Dilemmas in Septic Shock

Dilemmas in Septic Shock Dilemmas in Septic Shock William Janssen, M.D. Assistant Professor of Medicine National Jewish Health University of Colorado Denver Health Sciences Center A 62 year-old female presents to the ED with fever,

More information

Bronchitis/Pneumonia Core Content Keith Conover, M.D., FACEP /15/02 Clinical Spectrum Chest pain, shoulder pain, neck pain, abdominal pain,

Bronchitis/Pneumonia Core Content Keith Conover, M.D., FACEP /15/02 Clinical Spectrum Chest pain, shoulder pain, neck pain, abdominal pain, Bronchitis/Pneumonia Core Content Keith Conover, M.D., FACEP 1.0 10/15/02 Clinical Spectrum Chest pain, shoulder pain, neck pain, abdominal pain, headache Links with smoking, pollen count, FH of asthma

More information

(cilia) that help sweep away fluids and/or particles International Journal of Pharmaceutical Sciences and Research 2055

(cilia) that help sweep away fluids and/or particles International Journal of Pharmaceutical Sciences and Research 2055 IJPSR (2014), Vol. 5, Issue 5 (Research Article) Received on 29 November, 2013; received in revised form, 21 February, 2014; accepted, 16 April, 2014; published 01 May, 2014 EVALUATION OF EFFICACY AND

More information

Community Acquired Pneumonia in Adults Clinical Practice Guideline Antibiotic Stewardship

Community Acquired Pneumonia in Adults Clinical Practice Guideline Antibiotic Stewardship Community Acquired Pneumonia in Adults Clinical Practice Guideline Antibiotic Stewardship These guidelines are provided to assist physicians and other clinicians in making decisions regarding the care

More information

The IDSA/ATS consensus guidelines on the management of CAP in adults

The IDSA/ATS consensus guidelines on the management of CAP in adults The IDSA/ATS consensus guidelines on the management of CAP in adults F. Piffer F. Tardini R. Cosentini U.O. Medicina d'urgenza, Gruppo NIV, Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina

More information

PNEUMONIA IN CHILDREN. IAP UG Teaching slides

PNEUMONIA IN CHILDREN. IAP UG Teaching slides PNEUMONIA IN CHILDREN 1 INTRODUCTION 156 million new episodes / yr. worldwide 151 million episodes developing world 95% in developing countries 19% of all deaths in children

More information

Outpatient Management of Patients With Community Acquired Pneumonia Clinical Practice Guideline September 2013

Outpatient Management of Patients With Community Acquired Pneumonia Clinical Practice Guideline September 2013 Clinical Practice Guideline September 2013 General Principles: Community Acquired Pneumonia (CAP), together with influenza, remains the seventh leading cause of death in the United States. According to

More information

Care Guideline DRAFT for review cycle 08/02/17 CARE OF THE ADULT PNEUMONIA PATIENT

Care Guideline DRAFT for review cycle 08/02/17 CARE OF THE ADULT PNEUMONIA PATIENT Care Guideline DRAFT for review cycle 08/02/17 CARE OF THE ADULT PNEUMONIA PATIENT Target Audience: All MHS employed providers within Primary Care, Urgent Care, and In-Hospital Care. The secondary audience

More information

Getting Smart About: Upper Respiratory Infections

Getting Smart About: Upper Respiratory Infections Getting Smart About: Upper Respiratory Infections Daniel Z. Uslan, MD Assistant Clinical Professor Director, Antimicrobial Stewardship Program UCLA Health System Disclosures None relevant to the topic

More information

Antibiotics, Expectorants, and Cough Suppressants. Center For Cardiac Fitness Pulmonary Rehab The Miriam Hospital

Antibiotics, Expectorants, and Cough Suppressants. Center For Cardiac Fitness Pulmonary Rehab The Miriam Hospital Antibiotics, Expectorants, and Cough Suppressants Center For Cardiac Fitness Pulmonary Rehab The Miriam Hospital Objectives Review the mechanism of action (MOA), dosing, benefits, and various options for:

More information

Supplementary appendix

Supplementary appendix Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Blum CA, Nigro N, Briel M, et al. Adjunct prednisone

More information

PNEUMONIA. I. Background 6 th most common cause of death in U.S. Most common cause of infection related mortality

PNEUMONIA. I. Background 6 th most common cause of death in U.S. Most common cause of infection related mortality Page 1 of 8 September 4, 2001 Donald P. Levine, M.D. University Health Center Suite 5C Office: 577-0348 dlevine@intmed.wayne.edu Assigned reading: pages 153-160; 553-563 PNEUMONIA the most widespread and

More information

Bradley A. Sharpe, M.D. Associate Professor Medicine Department of Medicine UCSF -- William Osler, M.D.

Bradley A. Sharpe, M.D. Associate Professor Medicine Department of Medicine UCSF -- William Osler, M.D. Bradley A. Sharpe, M.D. Associate Professor Medicine Department of Medicine UCSF sharpeb@medicine.ucsf.edu a. An ailment that often leads to suffocation and death. b. A friend of the aged. c. A common

More information

Mædica - a Journal of Clinical Medicine

Mædica - a Journal of Clinical Medicine Mædica - a Journal of Clinical Medicine ORIGINAL PAPERS Mortality Risk and Etiologic Spectrum of Community-acquired Pneumonia in Hospitalized Adult Patients Cornelia TUDOSE, Assistant Professor of Pneumology;

More information

Respiratory tract infections. Krzysztof Buczkowski

Respiratory tract infections. Krzysztof Buczkowski Respiratory tract infections Krzysztof Buczkowski Etiology Viruses Rhinoviruses Adenoviruses Coronaviruses Influenza and Parainfluenza Viruses Respiratory Syncitial Viruses Enteroviruses Etiology Bacteria

More information

Pediatric Infections: Treatment of Resistant Pathogens. Focus : MRSA and DRSP Infections, Including Pneumonia. Blaise L. Congeni M.D.

Pediatric Infections: Treatment of Resistant Pathogens. Focus : MRSA and DRSP Infections, Including Pneumonia. Blaise L. Congeni M.D. Pediatric Infections: Treatment of Resistant Pathogens Focus : MRSA and DRSP Infections, Including Pneumonia Blaise L. Congeni M.D. Patient 1-LP 8 yo with 8 days of fever and 6 days of cough. She had consistently

More information

Background. Background. Background 3/14/2014. Conflict of Interest Statement:

Background. Background. Background 3/14/2014. Conflict of Interest Statement: Platform Presentations Comparison of zolpidem to other drugs associated with falls in hospitalized patients Ed Rainville, MSPharm. Conflict of Interest Statement: The speaker has no conflict of interest

More information

Guidelines/Guidance/CAP/ Hospitalized Child. PHM Boot Camp 2014 Jay Tureen, MD June 19, 2014

Guidelines/Guidance/CAP/ Hospitalized Child. PHM Boot Camp 2014 Jay Tureen, MD June 19, 2014 Guidelines/Guidance/CAP/ Hospitalized Child PHM Boot Camp 2014 Jay Tureen, MD June 19, 2014 CAP in Children: Epi Greatest cause of death in children worldwide Estimated > 2 M deaths in children In developed

More information

Disclosures. Case 1. Acute Bronchitis. Acute Bronchitis. Community-Acquired Pneumonia and other Respiratory Tract Infections. What do you recommend?

Disclosures. Case 1. Acute Bronchitis. Acute Bronchitis. Community-Acquired Pneumonia and other Respiratory Tract Infections. What do you recommend? Community-Acquired Pneumonia and other Respiratory Tract Infections none Disclosures Joel T. Katz, M.D. Associate Professor of Medicine Division of Infectious Diseases Brigham and Women s Hospital Case

More information

COPD exacerbation. Dr. med. Frank Rassouli

COPD exacerbation. Dr. med. Frank Rassouli Definition according to GOLD report: - «An acute event - characterized by a worsening of the patients respiratory symptoms - that is beyond normal day-to-day variations - and leads to a change in medication»

More information

Pneumonia (PN) Frequently Asked Questions (FAQs) 2Q09 and 3Q09. Adult Smoking History. Another Suspected Source of Infection

Pneumonia (PN) Frequently Asked Questions (FAQs) 2Q09 and 3Q09. Adult Smoking History. Another Suspected Source of Infection Pneumonia (PN) Frequently Asked Questions (FAQs) Adult Smoking History The nurse wrote patient smoker for 15 years but does not indicate when or if he quit. The physician in the H&P wrote "The patient

More information

Wright, Respiratory Infections in the Challenging Patient. Disclosures. Objectives

Wright, Respiratory Infections in the Challenging Patient. Disclosures. Objectives Respiratory Infections in the Challenging Patient Wendy L. Wright, MS, APRN, BC, FAANP, FAAN Adult / Family Nurse Practitioner Owner - Wright & Associates Family Healthcare Amherst, New Hampshire Owner

More information

Pneumonia in the Hospitalized

Pneumonia in the Hospitalized Pneumonia in the Hospitalized Patient: Use of Steroids Nicolette Myers, MD Pulmonary/Sleep/Critical Care November 9, 2018 Park Nicollet Clinic Facts About Pneumonia CAP is the 8 th most common cause of

More information

Community Acquired Pneumonia Pediatric Ages 3 month to 18 years Clinical Practice Guideline MedStar Health Antibiotic Stewardship

Community Acquired Pneumonia Pediatric Ages 3 month to 18 years Clinical Practice Guideline MedStar Health Antibiotic Stewardship Community Acquired Pneumonia Pediatric Ages 3 month to 18 years Clinical Practice Guideline MedStar Health Antibiotic Stewardship These guidelines are provided to assist physicians and other clinicians

More information

MANAGEMENT OF COMMUNITY ACQUIRED PNEUMONIA IN THE ASIA PACIFIC REGION

MANAGEMENT OF COMMUNITY ACQUIRED PNEUMONIA IN THE ASIA PACIFIC REGION MANAGEMENT OF COMMUNITY ACQUIRED PNEUMONIA IN THE ASIA PACIFIC REGION Chong-Kin LIAM Department of Medicine Faculty of Medicine University of Malaya Kuala Lumpur liamck@ummc.edu.my COMMUNITY ACQUIRED PNEUMONIA

More information

Community Acquired & Nosocomial Pneumonias

Community Acquired & Nosocomial Pneumonias Community Acquired & Nosocomial Pneumonias IDSA/ATS 2007 & 2016 Guidelines José Luis González, MD Clinical Assistant Professor of Medicine Outline Intro - Definitions & Diagnosing CAP treatment VAP & HAP

More information

Pediatric Respiratory Infections

Pediatric Respiratory Infections Pediatric Respiratory Infections Brenda Kelly PharmD BCPS Residency Program Director Virginia Mason Memorial, Yakima, Washington brendakelly@yvmh.org Disclosure The presenter has no actual or potential

More information

High dose amoxicillin for sinusitis

High dose amoxicillin for sinusitis High dose amoxicillin for sinusitis Amoxil ( amoxicillin ) is a commonly used penicillin antibiotic. It is produced in tablets (500 mg 875 mg), capsules, chewable tablets and oral suspensions. 6-3-2018

More information

Learning Objectives. Learning Objectives. Jim Roch, PA-C ASAPA Spring Meeting Sedona, Arizona March 5, pneumonias. Bacterial Viral Fungal

Learning Objectives. Learning Objectives. Jim Roch, PA-C ASAPA Spring Meeting Sedona, Arizona March 5, pneumonias. Bacterial Viral Fungal Jim Roch, PA-C ASAPA Spring Meeting Sedona, Arizona March 5, 2016 1 Learning Objectives Discuss the etiologies, clinical presentation, and approach to the management of the following pulmonary infections:

More information

To develop guidelines for the use of appropriate antibiotics for adult patients with CAP and guidance on IV to PO conversion.

To develop guidelines for the use of appropriate antibiotics for adult patients with CAP and guidance on IV to PO conversion. Page 1 of 5 TITLE: COMMUNITY-ACQUIRED PNEUMONIA (CAP) EMPIRIC MANAGEMENT OF ADULT PATIENTS AND IV TO PO CONVERSION GUIDELINES: These guidelines serve to aid clinicians in the diagnostic work-up, assessment

More information

Treatment of febrile neutropenia in patients with neoplasia

Treatment of febrile neutropenia in patients with neoplasia Treatment of febrile neutropenia in patients with neoplasia George Samonis MD, PhD Medical Oncologist Infectious Diseases Specialist Professor of Medicine The University of Crete, Heraklion,, Crete, Greece

More information

Infections of the head, neck, and lower respiratory tract

Infections of the head, neck, and lower respiratory tract Infections of the head, neck, and lower respiratory tract Infections of the upper respiratory tract Common 25% bacteria antibiotics 75% viruses Diagnosis on clinical grounds Nonspecific infections of the

More information

Cardiovascular and Respiratory Disorders

Cardiovascular and Respiratory Disorders Cardiovascular and Respiratory Disorders Blood Pressure Normal blood pressure is 120/80 mmhg (millimeters of mercury) Hypertension is when the resting blood pressure is too high Systolic BP is 140 mmhg

More information

Community Acquired Pneumonia - Pediatric Clinical Practice Guideline MedStar Health Antibiotic Stewardship

Community Acquired Pneumonia - Pediatric Clinical Practice Guideline MedStar Health Antibiotic Stewardship Community Acquired Pneumonia - Pediatric Clinical Practice Guideline MedStar Health Antibiotic Stewardship These guidelines are provided to assist physicians and other clinicians in making decisions regarding

More information

27/11/2012. Parainfuenza 1, 2 3 Rhinovirus Coronavirus Adenovirus Respiratory syncytial virus (RSV) Chlamydophila pneumoniae Mycoplasma pneumonite

27/11/2012. Parainfuenza 1, 2 3 Rhinovirus Coronavirus Adenovirus Respiratory syncytial virus (RSV) Chlamydophila pneumoniae Mycoplasma pneumonite 8 «Evidence-based Medicine-» 27/11/2012,,,, : :,,,,,,,, (30%-50%) () (5%-10%) (40%-50%) 20% Infuenza A B Parainfuenza 1, 2 3 Rhinovirus Coronavirus Adenovirus Respiratory syncytial virus (RSV) Chlamydophila

More information

Session: How to manage and prevent the different faces of pneumonia Severe CAP

Session: How to manage and prevent the different faces of pneumonia Severe CAP Athens 19, 20 November 2015 Garyfallia Poulakou Consultant, Infectious Diseases 4 th Department of Internal Medicine, Attikon University Hospital of Athens Session: How to manage and prevent the different

More information

Severe β-lactam allergy. Alternative (use for mild-moderate β-lactam allergy) therapy

Severe β-lactam allergy. Alternative (use for mild-moderate β-lactam allergy) therapy Recommended Empirical Antibiotic Regimens for MICU Patients Notes: The antibiotic regimens shown are general guidelines and should not replace clinical judgment. Always assess for antibiotic allergies.

More information

MCH-Immunization Conference. September 2012

MCH-Immunization Conference. September 2012 MCH-Immunization Conference September 2012 Rosalyn Singleton MD Arctic Investigations Program-CDC Alaska Native Tribal Health Consortium, Anchorage, AK DISCLAIMER: The results and conclusions presented

More information

Unit II Problem 2 Pathology: Pneumonia

Unit II Problem 2 Pathology: Pneumonia Unit II Problem 2 Pathology: Pneumonia - Definition: pneumonia is the infection of lung parenchyma which occurs especially when normal defenses are impaired such as: Cough reflex. Damage of cilia in respiratory

More information

Preventing and Treating Community-Acquired Pneumonia

Preventing and Treating Community-Acquired Pneumonia PL Detail-Document #310618 This PL Detail-Document gives subscribers additional insight related to the Recommendations published in PHARMACIST S LETTER / PRESCRIBER S LETTER June 2015 Preventing and Treating

More information

PBL RESPIRATORY SYSTEM DR. NATHEER OBAIDAT

PBL RESPIRATORY SYSTEM DR. NATHEER OBAIDAT PBL RESPIRATORY SYSTEM DR. NATHEER OBAIDAT Dr started to talk about his specialty at the hospital which is (ICU-Pulmonary-Internal Medicine). Pulmonary medical branch is a subspecialty of internal medicine.

More information

Pneumonia 2017 OMAR PIRZADA

Pneumonia 2017 OMAR PIRZADA Pneumonia 2017 OMAR PIRZADA Pneumonia Pneumonia is common 0.5-1% of adults per year, 5-12% presenting to GP with LRTi 22-42% will be admitted to hospital Symptoms and signs Case 1 26 year old man Sudden

More information

The Old Man s Friend (And the Ire of Many an ED QI Director) Objectives. Terminology 10/22/2009

The Old Man s Friend (And the Ire of Many an ED QI Director) Objectives. Terminology 10/22/2009 Pneumonia Management & Chris Fee, MD Assistant Clinical Professor UCSF Department of Emergency Medicine The Old Man s Friend (And the Ire of Many an ED QI Director) 7th leading cause of death in US 915,000

More information

Community Acquired Pneumonia. Background & Rationale to North American Guidelines. Lionel Mandell MD FRCPC Brussels Belgium

Community Acquired Pneumonia. Background & Rationale to North American Guidelines. Lionel Mandell MD FRCPC Brussels Belgium Community Acquired Pneumonia Background & Rationale to North American Guidelines Lionel Mandell MD FRCPC Brussels Belgium Consider Impact of the disease Issues to reflect upon Impact of the Disease 3-4

More information

JAC Efficacy and tolerance of roxithromycin versus clarithromycin in the treatment of lower respiratory tract infections

JAC Efficacy and tolerance of roxithromycin versus clarithromycin in the treatment of lower respiratory tract infections Journal of Antimicrobial Chemotherapy (1998) 41, Suppl. B, 69 73 JAC Efficacy and tolerance of roxithromycin versus clarithromycin in the treatment of lower respiratory tract infections G. Tatsis*, G.

More information

Respiratory Medicine. Some pet peeves and other random topics. Kyle Perrin

Respiratory Medicine. Some pet peeves and other random topics. Kyle Perrin Respiratory Medicine Some pet peeves and other random topics Kyle Perrin Overview 1. Acute asthma Severity assessment and management 2. Acute COPD NIV and other management 3. Respiratory problems in the

More information

Brice Taylor Assistant Professor Division of Pulmonary and Critical Care Medicine

Brice Taylor Assistant Professor Division of Pulmonary and Critical Care Medicine Brice Taylor Assistant Professor Division of Pulmonary and Critical Care Medicine Discuss advances in predicting prognosis Understand dwhat we know (and don t know) about the Microbiology Recognize important

More information

Things your mother never told you about antibiotics, UTI s, and Pneumonia. Rob Kaplan, MD July 12 and 14, 2017

Things your mother never told you about antibiotics, UTI s, and Pneumonia. Rob Kaplan, MD July 12 and 14, 2017 Things your mother never told you about antibiotics, UTI s, and Pneumonia Rob Kaplan, MD July 12 and 14, 2017 Objectives After this talk participants will: Be able to articulate some of the principles

More information

심사사례 성균관의대강북삼성병원감염내과 염준섭

심사사례 성균관의대강북삼성병원감염내과 염준섭 폐렴및호흡기질환의치료와 심사사례 성균관의대강북삼성병원감염내과 염준섭 서 론 미국 : 매년 560만명의환자발생 -- 20% 입원 사망률 - 외래에서치료가능한환자 : 1-5% - 입원치료가필요한환자 : 25% - 국내 ( 사망원인통계결과 ) : 2001년 ; 6.1명 /10만명, 1991년 ; 5.1명 /10만명 50-90% 가외래에서치료 30-40% 는원인을밝혀내지못함

More information

December 3, 2015 Severe Sepsis and Septic Shock Antibiotic Guide

December 3, 2015 Severe Sepsis and Septic Shock Antibiotic Guide Severe Sepsis and Septic Shock Antibiotic Guide Surviving Sepsis: The choice of empirical antimicrobial therapy depends on complex issues related to the patient s history, including drug intolerances,

More information

Community Acquired Pneumonia: Measures to Improve Management and Healthcare Quality

Community Acquired Pneumonia: Measures to Improve Management and Healthcare Quality Community Acquired Pneumonia: Measures to Improve Management and Healthcare Quality Gonzalo Bearman MD, MPH Assistant Professor of Internal Medicine Divisions of Quality Health Care & Infectious Diseases

More information

Community-Acquired Bacterial Pneumonia: Is There Anything New? Steve Vacalis DO CaroMont Health Regional Medical Center Gastonia, North Carolina

Community-Acquired Bacterial Pneumonia: Is There Anything New? Steve Vacalis DO CaroMont Health Regional Medical Center Gastonia, North Carolina Community-Acquired Bacterial Pneumonia: Is There Anything New? Steve Vacalis DO CaroMont Health Regional Medical Center Gastonia, North Carolina This presentation is sponsored by: and supported by an educational

More information

Issues Abx request. Sneezing w/ post- nasal d/c & redness mucous membranes Throat. Chest px w/ coughing, difficulty breathing

Issues Abx request. Sneezing w/ post- nasal d/c & redness mucous membranes Throat. Chest px w/ coughing, difficulty breathing Week 5 Magic Bullets URTI + Pneumonia Presenting Sx Cough, sore throat & runny nose Aches & pains all over Shivers & fevers Respiratory Viruses Viruses causing flu Influenza A/B/C (orthomyxovirus) Respiratory

More information

PNEUMONIA. Pneumonia is an inflammation of the lungs caused by bacteria, viruses, fungi, rickettsiae and other microorganisms.

PNEUMONIA. Pneumonia is an inflammation of the lungs caused by bacteria, viruses, fungi, rickettsiae and other microorganisms. PNEUMONIA Dr. A.Torossian, M.D., Ph. D. Department of Respiratory Diseases Definition Pneumonia is an inflammation of the lungs caused by bacteria, viruses, fungi, rickettsiae and other microorganisms.

More information

What is sepsis? RECOGNITION. Sepsis I Know It When I See It 9/21/2017

What is sepsis? RECOGNITION. Sepsis I Know It When I See It 9/21/2017 Sepsis I Know It When I See It September 15, 2017 Matthew Exline, MD MPH Medical Director, Medical ICU What is sepsis? I shall not today attempt further to define the kinds of material [b]ut I know it

More information

Diagnosis: Allergies:

Diagnosis: Allergies: Patient Name: Diagnosis: Allergies: ICU Sepsis Version 5 1/11/17 This order set must be used with an admission order set if patient not already admitted. Nursing Orders Verify that cultures have been obtained

More information

Acute Bacterial Sinusitis: The latest treatment recommendations. Objectives Having completed the learning activities, the participant will be able to:

Acute Bacterial Sinusitis: The latest treatment recommendations. Objectives Having completed the learning activities, the participant will be able to: Acute Bacterial Sinusitis: The latest treatment recommendations Presented by: Monica Tombasco, MS, MSNA, FNP-BC, CRNA Senior Lecturer Fitzgerald Health Education Associates, Inc., North Andover, MA Emergency

More information

Turkish Thoracic Society

Turkish Thoracic Society Türk Toraks Derneği Turkish Thoracic Society Pocket Books Series Diagnosis and Treatment of Community Acquired Pneumonia in Children Short Version (Handbook) in English www.toraks.org.tr This report was

More information

Within the past decade, the number of

Within the past decade, the number of CME EARN CATEGORY I CME CREDIT by reading this article and the article beginning on page 48 and successfully completing the posttest on page 53. Successful completion is defined as a cumulative score of

More information

Self-study course. Pneumonia

Self-study course. Pneumonia Self-study course Pneumonia This brochure is available in alternate formats. Call 1-800-282-8096 (V/TTY) 2 Course objectives: At the end of this course you will be able to: 1) Identify a series of steps

More information

10/2/2017. Pneumonia: Are We Missing the Mark? Objectives. Pneumonia

10/2/2017. Pneumonia: Are We Missing the Mark? Objectives. Pneumonia Pneumonia: Are We Missing the Mark? LaDawna Goering, DNP, APN, ANP-BC Nick Van Hise, Pharm. D, BCPS Objectives Diagnose Pneumonia Evaluate severity of illness tools and site of care decisions Review diagnostic

More information

DELL CHILDREN S MEDICAL CENTER EVIDENCE-BASED OUTCOMES CENTER. Community Acquired Pneumonia

DELL CHILDREN S MEDICAL CENTER EVIDENCE-BASED OUTCOMES CENTER. Community Acquired Pneumonia DELL CHILDREN S MEDICAL CENTER Community Acquired Pneumonia LEGAL DISCLAIMER: The information provided by Dell Children s Medical Center of Texas (DCMCT), including but not limited to Clinical Pathways

More information

Practice Guidelines for the Management of Community-Acquired Pneumonia in Adults

Practice Guidelines for the Management of Community-Acquired Pneumonia in Adults 000 GUIDELINES FROM THE INFECTIOUS DISEASES SOCIETY OF AMERICA Practice Guidelines for the Management of Community-Acquired Pneumonia in Adults John G. Bartlett, 1 Scott F. Dowell, 2 Lionel A. Mandell,

More information