The Curbsiders Internal Medicine Podcast

#76: Pneumonia Pearls with Dr Robert Centor

January 1, 2018
67 min

Conquer community acquired pneumonia and avoid misdiagnosis with tips from Dr. Robert Centor, Professor Emeritus University of Alabama and newly appointed Chair of Medicine at Kashlak Memorial Hospital. We discuss diagnosis, misdiagnosis, procalcitonin, steroids for severe pneumonia, pneumonia severity index versus CURB-65, and how to determine antibiotic choice and duration. Special thanks to Correspondents Neela Bhajandas (cohost), Justin Berk and Bryan Brown who all contributed several articles, resources, and questions to prep for this show. Cover image by Dr Kate Grant paintscientific.com.

Full show notes available at http://thecurbsiders.com/podcast

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Time Stamps

  • 00:00 Intro
  • 02:38 Brief bio for Dr Centor
  • 04:22 Picks of the week with Dr Centor
  • 11:27 Clinical case of suspected pneumonia
  • 12:30 Brief history of community acquired pneumonia
  • 14:40 Misdiagnosis rates are high
  • 16:18 Defining diagnostic criteria for pneumonia
  • 18:50 Chest x rays and pneumonia
  • 22:18 Illness scripts teaching about pneumonia
  • 23:41 Ubiquitous misunderstanding of pneumonia definition
  • 25:26 History and physical exam tips from Dr Centor
  • 27:19 Further testing for pneumonia, PSI, CURB-65
  • 32:50 Procalcitonin discussed
  • 38:10 Antibiotic choice discussed with Dr Bhajandas
  • 41:15 Safety considerations for various antibiotics
  • 43:38 Use of high dose amoxicillin
  • 44:45 Dr Centor’s antibiotic preferences, and some thoughts on blood and sputum cultures
  • 46:55 Dangers of fluoroquinolones
  • 48:25 Antibiotic duration
  • 51:40 HCAP is no longer a thing and how to assess risk for drug resistant organisms
  • 55:42 Corticosteroids for pneumonia
  • 60:25 Inpatient antibiotic choices
  • 62:00 Dr Centor’s take home points
  • 62:45 Dr Centor becomes Chair of Kashlak Memorial
  • 65:38 Outro

Tags: pneumonia, community, acquired, cap, antibiotic, duration, diagnosis, misdiagnosis, strep, cough, procalcitonin, steroids, fluoroquinolones, azithromycin, drug, resistant, mdro, illness, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medical, medicine, practitioner, professional, primary, physician, resident, student

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