This is a draft cheat sheet. It is a work in progress and is not finished yet.
COMMUNITY - ACQUIRED PNEUMONIA (CAP)
strep pneumoniae |
HEALTHY OUTPATIENT ADULTS NO COMORBIDITIES:
Amoxicillin 1 g TID - BEST EVIDENCE |
Penicillin ALRG:
Doxycycline 100 mg BID
Clarithromycin 500 mg BID
Azithromycin 500 mg x1 then 250 mg QD
|
OUTPATIENT ADULTS W COMORBIDITIES:
Augmentin & Macrolide (azithromycin; calrithromycin)
OR Doxycycline |
Pneumonia Prevention: Vaccinate
Pneumococcal - 65y; 19-64ycomorbidities |
General rule: you want to give the abx for at least 48h after you have achieved symptom resolution. So minimum CAP TX is 5d if symptoms mod-severe 7 days! |
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DIFFERENTIAL DX: COUGH
CLUES TO DX |
"chest tightness" |
asthma, cardiac ischemia |
"suffocating" |
pulmonary edema |
"increase work to breath" |
COPD, asthma myopathy |
"air hungry" |
HF, PE, asthma, COPD |
"winded" OR "breathing heavy" |
deconditioning |
|
|
COPD
Differential DX |
Chronic Bronchitis |
NML spirometry |
Asthma |
Bronchiectasis |
CT bronchial wall thickening |
Heart Failure |
Dilated heart on CXR |
PE |
Tuberculosis |
I will confirm COPD w Spirometry
FEV1/FVC post-bronchodilation less than 0.7 confirms COPD |
|
|
COPD Prescribing "ABE"
Group A |
LAMA or LABA + SABA prn |
Tiotropium qd + Albuterol prn |
Formoterol qd + Albuterol prn |
Group B |
LAMA &/or LABA + SABA prn |
|
Group A & B do not have to be hospitalized
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