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1、OutpatientantibioticuseCarlosA.DiazGranados,MD,MSDirector,AntimicrobialUtilizationGMHCase148yomale,HIVonARV,VL75k,CD4=120,comestothecliniccomplainingofnasalcongestionwithyellow-thickdischarge,cough,postnasaldripandheadachefor4days.Physicalexamrevealsnormalvitalsi
2、gns,tendernesstopressureinmaxillarysinusandyellowpostnasaldrip.WBC4k,CryptoAGnegative.Whatisthediagnosis?Whatisantimicrobialshouldbegiven?AcutesinusitisACPGuidelinesHigh-risk(>50%)ofbacterialsinusitisif2ormoreofthefollowingpresent:Symptoms>7days.Facialpain.Purule
3、ntdischarge.Iflowrisk,donotprescribeantibiotics.Ifhigh-riskandmildsymptoms,deferantibiotictherapy.Ifnoimprovementafter7-10daysofsymptomatictherapy,considerantibiotictherapy.Ifhigh-riskandseveresymptoms,considerimmediateantibiotictherapy.TheantibioticofchoiceisAmo
4、xicillin.Assesstheprobabilityofbacterialsinusitisandtreatifhighandsymptomssevere.Otherwise,deferantibioticRx.Redflags…considerearly/immediateantibioticsSinusitis–ABdurationUnclearRCThaveused5-10days.Case224yomale,recentlydiagnosedwithHIV,CD4is180onBactrimprophyla
5、xis,startedARV2monthsprior.Comestotheclinicwith3daysofmildshortnessofbreath,productivecoughofyellow/greensputum.PEafebrile,lungswithfewbilateralwheezes.O2sat99%RAbeforeandafteractivity.LDHnormal,CXRaynegative.Whatisthediagnosis?Whatisthefirstlineantibioticchoice?
6、AcutebronchitisAntibioticsNOTrecommendedCase335yomale,h/oHIV,CD4150,VLundetectable,comeswitha5dayshistoryofSOB,productivecough,andlow-gradefever.Adherence100%.Meds:Atripla,Bactrim.PE:T=100,RR=22,HR=98,BP=110/70.DecreasebreathsoundsandralesRLL.O2sat94%RA.Labs:PaO2
7、72.WBC=12.LDH=180.Whatisthelikelydiagnosis?Whatwouldbeyourrecommendedtherapy?Community-acquiredpneumoniaPCPvs.BacterialPCPvs.BacterialCAPCID2007;44:Suppl2.SiteofcaredecisionsPSIScoringCURB–65ScoreConsiderrulingoutTBallpatientsthatyoutreatforbacterialpneumoniawith
8、quinolonemonotherapyCase452yomalewithHIV,CD4350,VLundetectable,chronictobaccouse,historyofchronicbronchitis/COPD,comestotheclinicwith5daysofworseningshortnesso
