MosaicED Brain Teaser!
You're having an atypical day,
in your atypical way,
you woke up out of bed
and had a shower standing on your head,
arrived at work and your boss said;
Which of the following drugs is useful in the treatment of an atypical pneumonia?
- B-Augmentin DF (co-amoxiclav)
D-Clarithromycin. Typical and atypical is not a way of describing how common a bug is but the way it presents. Some typical organisms: strep pneumonia, staph pneumonia (necrotising), haemophilus influenza, bordetella, klebsiella. Some atypical organisms: psittacosis (birds), q fever/coxiella burnetti (abattoir), mycoplasma pneumonia (nonproductive cough, bilateral lower lobe patchy shadowing), TB, legionella, viruses.
Typical: No prodrome, generalised symptoms, acute illness, good resp symptoms, signs +. Chest x ray: usually diagnostic, lobar & dense, unilateral
Atypical: Prodrome, myalgia, lethargy, rash, sub acute, resp symptoms late in the disease, signs absent. Chest x ray: not reliable, patchy, bilateral
Treatment: Make sure you get >3 sputum cultures as they only grow something 30-40% of times. and 2 blood cultures before antibiotics and culture every time the spike a fever until you get growth. Treat empirically - atypicals can usually be covered by doxycycline or a macrolide, check eTG and your hospital guidlines.