Therapy- Croup/RSV/PNA – Flashcards
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What ratio of amoxicillin:clavulanate in Augmentin should be used for CAP?
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14:1 (suspension = Augmentin ES-600)
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If other concentrations of Augmentin are used that provide too much clavulanate, there is an increased risk of which adverse effect?
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Diarrhea
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What are treatment pearls of CAP in pediatrics?
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Do not exceed adult doses of antimicrobials, in areas where S. pneumo is relatively resistant amox/Augmentin should be administered in 3 divided doses, and for fully susceptible strains twice daily administration is acceptable
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Why should amoxicillin or Augmentin be administered in 3 divided doses in areas where S. pneumo is relatively resistant?
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To stay above MIC because of concentration dependent killing
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What is the most narrow-spectrum and effective antimicrobial against S. pneumoniae?
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Penicillin G
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How does Penicillin G efficacy change based on route of administration?
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Effective against organisms with MIC <2 mcg/mL if administered parenterally and against MIC <0.06 mcg/mL if administered orally
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T/F: All oral cephalosporins are inferior to high dose amoxicillin for S. pneumo treatment
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True
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How should S. pneumo treatment be managed for patients with a PCN allergy?
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DOC: Levofloxacin Last line: Macrolide
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What are IV therapies for S. pneumo?
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High dose beta-lactams (PCN G every day in regions with high level PCN resistance), Ceftriaxone, or Cefotaxime
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Which IV therapy for S. pneumo is the best to use? Why?
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Ceftriaxone because it is substantially more active in vitro against PCN-resistant strains than PCN G
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In which setting is S. aureus most often initially treated?
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Inpatient
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What is the DOC for MSSA?
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Oxacillin or Nafcillin (beta-lactamase-stable penicillins)
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In addition to oxacillin and nafcillin, which other abx can be used to treat MSSA?
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Cefazolin (Ancef)
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What is the drug of choice for serious infections of CA-MRSA?
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Vancomycin
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What is 2nd line therapy for CA-MRSA?
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Linezolid
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In which patients may linezolid be particularly advantageous for treatment of CA-MRSA?
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Pre-existing renal dysfunction
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Is linezolid bacteriostatic or bactericidal?
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Bacteriostatic
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What are major ADRs of linezolid?
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Significant HA and myelosuppression
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Which agent should NOT be used for treatment of CA-MRSA because it is inactivated by pulmonary surfactant?
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Daptomycin
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What is an alternative agent for both MSSA & MRSA for susceptible strains?
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Clindamycin
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Mycoplasma pneumoniae is more common in which populations?
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School-aged children and adults
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Which agents are used to treat Mycoplasma?
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Macrolides or tetracyclines (?8 years old)
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Which antibiotics are "not inferior" to macrolides or tetracyclines in adults for Mycoplasma?
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Respiratory FQs (levofloxacin)
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What is the drug of choice for Mycoplasma? Why?
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Azithromycin due to least drug interactions, tolerability, improved adherence, and IV/PO formulations
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How can antimicrobial resistance be minimized?
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Limit exposure to any antimicrobial whenever possible, limit spectrum of activity of antimicrobials when pathogen is identified, use proper dosing of antimicrobial, and treat for shortest effective duration
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*What is the duration of CAP treatment?*
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10 days has been best studied but shorter courses may be just as effective for mild disease managed in the outpatient setting
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T/F: MRSA infections may require longer treatment than those caused by S. pneumo
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True
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*Vaccine prevention*
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1st time child receives influenza vaccine they need 2 doses separated by 1 month up to 8 years old and every mother during every pregnancy should receive Tdap in 3rd trimester to decrease transmission of pertussis
