323.4 📋 章末速記 Summary

323.4.1 🔑 一句話總結

Viral pneumonia 識別率隨 molecular diagnostics (multiplex PCR) 普及大幅提升；common viruses：influenza A/B (seasonal + pandemic; oseltamivir 75 BID × 5 d within 48 hr or baloxavir single dose)、RSV (infants + elderly + IS; 2023 NEW Arexvy/Abrysvo vaccines for ≥ 60 + nirsevimab for infants)、SARS-CoV-2 / COVID-19 (multi-variant; outpatient Paxlovid within 5 d, hospitalized dexamethasone + remdesivir, severe + tocilizumab/baricitinib)、parainfluenza、adenovirus、metapneumovirus、rhinovirus、coronaviruses、MERS-CoV、measles + varicella、hantavirus；bacterial superinfection classic post-influenza (S. aureus MRSA + S. pneumoniae) — 用 vancomycin + standard CAP；prevention：annual influenza + updated COVID boosters + RSV vaccines ≥ 60 + pneumococcal + hand hygiene；long COVID (PASC) 10-30% survivors，multidisciplinary care。

323.4.2 💊 治療精要

• influenza：oseltamivir 75 mg BID × 5 days (start within 48 hr ideal)；baloxavir single oral dose alternative；peramivir IV single dose for severe
• RSV：supportive；ribavirin for transplant (limited efficacy)；palivizumab/nirsevimab for infant prophylaxis
• COVID outpatient (high-risk)：Paxlovid (nirmatrelvir/ritonavir) within 5 days；alternative remdesivir IV × 3 d or molnupiravir
• COVID hospitalized + O2：dexamethasone 6 mg × 10 d (RECOVERY) + remdesivir
• COVID severe：+ tocilizumab OR baricitinib (REMAP-CAP) for ↑ inflammation
• post-influenza bacterial pneumonia：vancomycin + ceftriaxone (cover S. aureus + S. pneumoniae)
• prevention：annual influenza vaccine + updated COVID boosters + RSV vaccines ≥ 60 (Arexvy, Abrysvo) + pneumococcal (PCV20) + hand hygiene + masks in healthcare

323.4.3 🎯 盧醫師的考前提醒

1. influenza 治療 within 48 hours ideal：oseltamivir 75 BID × 5 d；severe / hospitalized 可超過 48 hr 仍給；annual vaccine prevention
2. baloxavir (Xofluza) = single oral dose；同等效力 oseltamivir；adherence advantage
3. post-influenza bacterial pneumonia 最常見 S. aureus (often MRSA + PVL+)：severe + cavitating；vancomycin + standard CAP coverage
4. RSV 2023-2024 大突破：Arexvy (GSK) + Abrysvo (Pfizer) vaccines for adults ≥ 60；Abrysvo maternal vaccine 32-36 wk for infant protection；nirsevimab (Beyfortus) long-acting mAb for infants
5. COVID outpatient Paxlovid：within 5 days symptom onset；high-risk patients；89% reduction hospitalization (EPIC-HR)；many drug interactions (ritonavir CYP3A4)
6. COVID hospitalized treatment hierarchy：requires O2 → dexamethasone (RECOVERY) + remdesivir；severe + ↑ inflammation → + tocilizumab or baricitinib (REMAP-CAP)
7. anticoagulation in COVID：moderate (non-ICU) → therapeutic dose helps (ATTACC, ACTIV-4a)；ICU → prophylactic preferred
8. long COVID (PASC) 10-30%：dyspnea + fatigue + cognitive impairment + palpitations + POTS-like；multidisciplinary care；no specific antiviral
9. MERS-CoV：Middle East + camels；high mortality (~ 35%)；supportive care
10. hantavirus (Sin Nombre)：US Southwest + rodent exposure；HPS with rapid cardiopulmonary failure；high mortality；supportive (ECMO for refractory)