OS

213: Circulation and Respiration

LEC 05.2: ANTIBACTERIALS FOR RESPIRATORY TRACT INFECTIONS
Exam 2 | Cecilia C. Maramba-Lazarte, MD| August 23, 2012

OUTLINE

Table 4. LOW RISK CAP

I. Antibacterials for RTI

A. Viral Respiratory Infections
B. Choice of Antibiotics for
Bacterial Infections
C. Recommended Antibiotics for
Pedia CAP

II. Review of Antibiotics

A. Penicillin
B. Cephalosporins
C. Macrolides
D. Quinolones

Likely Pathogens
S pneumonia
H influenzae
C pneumoniae
M pneumoniae
M catarrhalis

This trans was based on the print-out of slides of Dr. Maramba.

I. ANTIBACTERIALS FOR RTI

A. VIRAL RESPIRATORY INFECTIONS
Many respiratory diseases may be viral in origin and does not
require antibiotics
o Rhinovirus, Adenovirus, Rubella, Corona Virus, Parainfluenza
Consider Efficacy, Safety and Cost
o Efficacy: based on target pathogens and prevailing resistance in
locality
o Local epidemiology, Age, Severity of Illness, Co-morbidities,
Hospital-Acquired

B. CHOICE OF ANTIBIOTICS FOR BACTERIAL INFECTIONS

Table 1. BACTERIAL ETIOLOGY OF RESPIRATORY TRACT INFECTIONS
Pharyngitis
Otitis media
Epiglottitis
Bronchitis
Sinusitis
Pneumonia
Lung Abscess

Group A Streptococcus
S. pneumoniae, H. influenzae
H. influenzae


S. pneumoniae, H. influenzae
Anaerobes

Empiric Therapy
Previously healthy:
Amoxicillin or extended macrolide
With stable comorbid illness:
Coamoxyclav OR
2nd gen cephalosporin OR extended macrolides

Table 5. MODERATE RISK CAP
Likely Pathogens
S pneumonia
H influenzae
C pneumoniae
M pneumoniae
M catarrhalis

Empiric Therapy
Previously healthy:
Amoxicillin or extended macrolide
With stable comorbid illness:
Coamoxyclav OR
2nd gen cephalosporin OR extended macrolides

Table 5. HIGH RISK CAP
Likely Pathogens
S pneumonia
H influenzae
C pneumoniae
M pneumoniae
M catarrhalis

Empiric Therapy
Previously healthy:
Amoxicillin or extended macrolide
With stable comorbid illness:
Coamoxyclav OR
2nd gen cephalosporin OR extended macrolides

Table 2. ANTIMICROBIAL RESISTANCE (%) by Disc Diffusion DOH

antimicrobial resistance surveillance Jan-Dec 2010
Pathogen
Strep.
pneumo
H.
influenza
M.
catarrhalis
S. aureus

Ampi
0

Chloro
5.9

Coamox
0

Cotri
21.1

Pen
0

Erythro
3.3

Cefu
0

16.5

12

34.5

24.2

17.1

47.6

45.9

95.3

6.3

5.8

54

8.7

C. RECOMMENDED ANTIBIOTICS FOR PEDIA CAP

Table 3. ANTIBIOTIC THERAPY FOR PEDIA CAP

Age

Suspected Organism

0-2
months
3 mos 5
years

Gram (-) Bacilli

>5 yrs
Hospital
Acquired

H. influenza,
S. pneumonia,
S. aureus

S. pneumoniae

Mild
Severe
Very
Severe

Empiric
Therapy
Ampicillin +
Aminogly
Amoxicillin
Pen G
Chloramphen.
Pen G

S. aureus, Gram (-) bacilli

Ceftazidime

Alternative
Therapy
rd
3 gen Ceph +
Aminoglycoside
nd
rd
2 or 3 gen
Cephalosporin
rd
3
gen
Cephalosporin
nd
rd
2 or 3 gen
Cephalosporin
Piperacillin-
Tazobactam

ACCORDING TO RISK STRATIFICATION & LIKELY ETIOLOGY
CAP Low risk

CAP Moderate risk
CAP High risk
HAP
Other etiologies

Mark, Cristina, Kevin

UPCM 2016 B: XVI, Walang Kapantay!

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