Respiratory Infections Education Series

​Respiratory Infections Education Series

By Alexa Risser, Victoria Lam, Joseph Goncalves

Multiple Choice

Which pathogen is the most common cause of CAP?

• Haemophilus influenzae

• Legionella pneumophila

• Mycoplasma pneumonia

• Streptococcus pneumoniae

Pathogens that lead to CAP

• 75% cases: Streptococcus pneumoniae

• 10-15% cases: Haemophilus influenzae

• ~20% cases: Mycoplasma pneumonia

• 5-15% cases: Chlamydophila pneumoniae

• 2-15% cases: Legionella pneumophila

Multiple Choice

Which antibiotic does NOT provide coverage for atypical organisms in a community acquired pneumonia?

• Cefuroxime

• Azithromycin

• Doxycycline

• Levofloxacin

Empiric Therapy for CAP

• The 2019 IDSA/ATS guideline states empiric treatment targeting the most likely organisms, antibiotic should cover BOTH typical (S. pneumoniae and H. influenzae) and atypical (M. pneumoniae, C. pneumoniae, and Legionella) organisms.

• Beta-lactams do NOT cover atypical pathogens as compared to macrolides, doxycycline, and fluoroquinolones

Multiple Choice

Based on the 2019 IDSA/ATS guidelines, what is the minimum duration of therapy? once the patient has reached clinical stability

• 1 day

• 3 days

• 5 days

• 7 days

Multiple Choice

Based on the 2025 ATS guidelines, what is the minimum duration of therapy once the patient has reached clinical stability?

• 1 day

• 3 days

• 5 days

• 7 days

CAP Duration of Therapy

• Durations are dependent on the patient reaching clinical stability (afebrile for 48-72 hours and stable, traditionally takes ~5 days)

• 2019 IDSA/ATS guideline: a minimum of 5 days

• 2025 ATS guideline: a duration of less than 5 days (minimum of 3 days)

Multiple Select

Based on the 2019 IDSA/ATS guidelines, what is the recommended treatment for CAP in a patient with diabetes and taking immunosuppressants?

• Levofloxacin

• Ciprofloxacin

• Augmentin + doxycycline

• Cefuroxime + azithromycin

CAP Treatment

The 2019 IDSA/ATS guidelines recommend that in patients who have CAP and the presence of comorbidities (diabetes, alcoholism, immunosuppression, asplenia) or use of antimicrobials in past 3 months, the treatment could be a respiratory fluoroquinolone (levofloxacin, moxifloxacin) OR a beta-lactam plus a macrolide/doxycycline 

Multiple Choice

Which is NOT a symptom of active tuberculosis?

• Cough lasting >3 weeks

• Fatigue

• Weight gain

• Chills

Active TB Symptoms

• Cough lasting longer than 3 weeks with or without hemoptysis

• Chest pain

• Weakness/fatigue

• Weight loss

• Chills, fever, night sweats

Multiple Choice

What is a treatment option for active TB?

• Rifampin + isoniazid + moxifloxacin

• Rifampin + isoniazid + pyrazinamide + ethambutol

• Rifapentine + ethambutol

• Isoniazid monotherapy

Active TB Treatment

• RIPE – rifampin + isoniazid + pyrazinamide + ethambutol

  • Starts with RIPE daily for 2 months, followed by just rifampin + isoniazid daily for 4-7 months (total treatment length = 6-9 months)

• Rifapentine + isoniazid + moxifloxacin + pyrazinamide x 2 months, then rifapentine + isoniazid + moxifloxacin x 9 weeks

Multiple Select

What are treatment options for latent TB?

• Isoniazid + rifapentine once weekly for 3 months

• Isoniazid + rifampin daily for 3 months

• Rifampin monotherapy daily for 4 months

• Isoniazid daily for 6-9 months

Latent TB Treatment

• Isoniazid + rifapentine once weekly for 3 months 

• Isoniazid + rifampin daily for 3 months 

• Rifampin monotherapy once daily for 4 months 

• Isoniazid daily (or twice weekly) for 6 or 9 months

  • Not preferred due to length of treatment 

Multiple Choice

Which medication must be given concurrently with vitamin B6 25-50 mg/day to prevent neuropathy?

• Rifampin

• Isoniazid

• Pyrazinamide

• Ethambutol

Multiple Choice

Which medication must be taken on an empty stomach with a glass of water?

• Pyrazinamide

• Rifapentine

• Ethambutol

• Rifampin

TB Medications Counseling

• Must be taken with food: rifapentine

• Must be taken on an empty stomach: rifampin, isoniazid

• May be taken with or without food: pyrazinamide, ethambutol, moxifloxacin

Multiple Choice

Which medication has a potential side effect of optic neuritis?

• Moxifloxacin

• Ethambutol

• Pyrazinamide

• Rifapentine

Multiple Choice

Which medication would you avoid using to treat TB in a patient experiencing an acute gout attack?

• Rifampin

• Ethambutol

• Moxifloxacin

• Pyrazinamide

Pyrazinamide

• Potential side effect of worsening gout

• Contraindicated in patients with acute gout and severe hepatic impairment

Multiple Select

Which medications put patients at a high risk of progression to severe COVID-19 illness?

• High-dose corticosteroids (>20 mg prednisone or equivalent for >4 weeks)

• B-cell depleting drugs in the past 12 months

• Anti IL-23 drugs

• Tyrosine kinase inhibitors

• Corticosteroids 10-20 mg for >4 weeks

• Anti IL-6, IL-12, and IL-23 drugs

Moderate risk:

• B-cell depleting agents in the past 12 months (rituximab, ocrelizumab)

• Abatacept

• Tyrosine kinase inhibitors (ibrutinib, acalabrutinib)

• High-dose corticosteroids (>20mg prednisone or equivalent for >4 weeks)

• CAR-T therapy in past 12 months

High risk:

Therapeutics associated with higher risk of progression to severe COVID-19 illness

Multiple Choice

What is the first-line treatment of COVID-19 if no contraindications exist and there are no severe DDI?

• Remdesivir

• Nirmatrelvir/

  ritonavir

• Oseltamivir

• Molnupiravir

Treatment for COVID-19

1. If no contraindications exist or there are no severe drug interactions, nirmatrelvir/ritonavir (Paxlovid) is recommended as first line.

2. If Paxlovid is not clinically appropriate and IV medications are feasible, remdesivir (Veklury) is recommended as a second line agent

3. Molnupiravir (Logevrio) is recommended as the last line agent if Paxlovid and Veklury are not appropriate/feasible.

Multiple Choice

You must initiate Paxlovid and Logevrio within ___ days of symptom onset whereas you must initiate Veklury within ___ days of symptom onset.

• 1; 2

• 7; 5

• 5; 7

• 2; 1

Multiple Choice

Which COVID-19 treatment does not have any CYP interactions?

• Remdesivir

• Nirmatrelvir/

  ritonavir

• Veklury

• Molnupiravir

Drug interactions

• Nirmatrelvir/ritonavir (Paxlovid): ritonavir is a strong CYP3A4 inhibitor

• Remdesivir (Veklury): minor CYP3A4 inhibitor

• Molnupiravir (Logevrio): no CYP interactions!

Multiple Choice

Which COVID-19 treatment is given intravenously?

• Paxlovid

• Remdesivir

• Molnupiravir

• Logevrio

Multiple Choice

Influenza antivirals should be initiated within what time frame after symptom onset?

• 12 hours

• 24 hours

• 48 hours

• 72 hours

Multiple Choice

Which health condition/population is not a risk factor for progression to severe influenza illness?

• Heart failure

• HIV/AIDS

• Pregnant patients

• Age 5-64 years old

Risk factors for severe influenza illness

• Pregnant patients

• Immunocompromised patients

• Children <5 years of age and adults >65 years of age

• Diabetes

• Asthma

• Atherosclerotic disease, heart failure

• HIV/AIDS

Multiple Choice

Which are side effects of oseltamivir?

• Nausea/

  vomiting

• Neuropsychiatric events (confusion, delirium)

• Headache

• Bronchospasm

Multiple Choice

Which influenza treatment cannot be used in pregnancy?

• Zanamivir

• Peramivir

• Baloxavir

• Oseltamivir

Multiple Choice

Which influenza antiviral comes as a dosage form of a Diskhaler?

• Zanamivir

• Baloxavir

• Oseltamivir

• Peramivir

• Treatment dose: 2 inhalations twice daily for 5 days

• Prophylactic dose: 2 inhalations once daily for 7 days

• Not recommended for patients with asthma/COPD​

Relenza Diskhaler (zanamivir)

Multiple Select

Which influenza vaccine should be given to a patient with an egg allergy?

• Fluzone

• Flublok

• Fluarix

• Fluad

Influenza vaccine

As of the 2023-2024 influenza season, patients with an egg allergy can receive any influenza vaccine with no additional safety measures, regardless of the severity of their previous reaction to eggs.

Thank you for joining and for your participation!