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Teaching Script Author: Lindsay WeissTopic: Narrow vs. Broad Spectrum Antibiotics for Community Acquired Pneumonia (CAP)Identify the TriggerBased on patient situation/learnerLearner states, “In this patient admitted pneumonia, I would like to start him/her on ceftriaxone”High Yield Teaching PointWhat do they need to know that will impact their care of patientsEmpiric therapy with a third-generation parenteral cephalosporin is not routinely necessary for the treatment of uncomplicated CAP. It is safe to use ampicillin or penicillin G for children hospitalized with uncomplicated CAP. Identify EBMFind your sources and specific evidenceBradley JS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clinical infectious diseases. 2011; 53(7):617-630IDSA guidelines recommended the empiric use of narrow-spectrum coverage with ampicillin or penicillin G for children hospitalized with uncomplicated CAP.Queen MA, et al. Comparative effectiveness of empiric antibiotics for community-acquired pneumonia. Pediatrics 2014; 133(1):e23-29.Narrow-spectrum therapy was not inferior to broad-spectrum antibiotics in all measured outcomes including LOS, duration of oxygen, duration of fever, or readmission rates within 7 days.Describe StrategyInteractive, analogies, visualsOne Minute Preceptor Keep Script Brief5-15 minutes; what are your key pointsGet commitment: “So you want to prescribe Ceftriaxone?”Probe for evidence: “Why?”General Rule: Empiric therapy with a third-generation parenteral cephalosporin (e.g. ceftriaxone or cefotaxime) should be prescribed for hospitalized children who are not fully immunized, in regions where local epidemiology of invasive pneumococcal strains documents high-level penicillin resistance, or for infants and children with life-threatening infection, including those with empyema. In immunized children with uncomplicated CAP, empiric therapy should be ampicillin or penicillin. Reinforcing/constructive feedback: depending on their answer/presentation Additional Script: What organisms are most commonly implicated in CAP?Only 15% of CAP are bacterial in origin, viral infections are the most common causes of CAP in hospitalized children Streptococcus pneumoniae is the most common bacterial etiology of CAP S. pneumoniae followed by MRSA are the most common cause of complicated CAP (e.g. empyema, abscess, moderate to large effusion, necrosis). Adapted from Lang. et al. Collaborative development of teaching scripts: an efficient faculty development approach for a busy clinical teaching unit. J Hosp Med. 2012; Oct 7(8): 644-8.Please click to complete a short 2-minute survey! Teaching Script ID #: 10 ADDIN EN.REFLIST ................
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