Dr.

Suda Vannaprasaht Department of Pharmacology, Faculty of Medicine, Khon Kaen University

Objective
Review common respiratory tract infection Review common antibiotics for general practitioner ATB used for respiratory tract infection

Upper respiratory tract infection

Otitis media Sinusitis Pharyngitis

Lower respiratory tract infection

Acute bronchitis Pneumonia

Community

acquire pneumonia Hospital acquire pneumonia

Gram positive: - Penicillins:

Aminopenicillin -lactam

: amplicillin, amoxicillin

ATB+ -lactamase inhibitors

+ sulbactam (Unasyn) + clavulanic acid (Augmentin)

Amplicillin Amoxicillin

1st, 2nd Generation cephalosporins

Cefuroxime

Gram positive (cont.) - Vancomycin (MRSA) - Macrolides:

-

Erythromycin, roxithromycin, azithromycin, clarithromycin

Gram negative
Aminoglycosies Fluoroquinolones:

ciprofloxacin,

levofloxacin

3rd generation cephalosporin

Ceftriazone Ceftazidime.

Cefoperazone penicillins: piperacillin

Penicillins:
antipseudomonase

Maclorides

Anaerobic bacteria
Metronidazole Clindamycin -lactam ATB+ -lactamase inhibitors

Inflammation of the middle ear Otalgia, fever and irritability Most common in infants and children Usually follows a viral URI that cause Eustachian tube dysfunction and mucosal swelling in middle ear Bacterial and viruses that colonize the nasopharynx thus enter middle ear

Acute otitis media

Acute otitis media

Antimicrobial therapy
Amoxicillin Amoxicillin+clavulanate Cefuroxime

Diseases Acute otitis media

Usual Pathogens S. pneumoniae H. influenzae M. Catarrhalis

Treatment Amoxicillin Amoxicillin+clavulanate Cefuroxime

Inflammation and/or infection of the paranasal sinus mucosa

Viral sinusitis and bacterial sinusitis are difficult to differentiate because clinical presentation are similar

viral URI causes mucosal inflammation, lead to

obstruction of sinus ostia

Sinusitis
Mucosal secretions become trapped, local defenses are impaired and bacteria from adjacent surfaces begin to proliferate Acute and chronic

Sinusitis
Usual Pathogens for acute sinusitis
Viral Bacterial

pneumoniae H. influenzae M. catarrhalis Usual Pathogens for chronic sinusitis

S.

Polymicrobial with an increased prevalence of anaerobes

Sinusitis

Antimicrobial therapy
Amoxicillin Amoxicillin+clavulanate Cefuroxime Clarithromycin Azithromycin Clindamycin

Diseases Acute otitis media

Usual Pathogens S. pneumoniae H. influenzae M. Catarrhalis Same

Treatment Amoxicillin Amoxicillin+clavulanate Cefuroxime

Acute sinusitis

Amoxicillin Amoxicillin+clavulanate Cefuroxime

Acute infection of the oropharynx and nasopharynx Most common is viral infection Common bacterial infection

Group A -hemolytic Streptococcus

S. pyogenase

Sore throat, fever, pain on swallowing, erythema of tonsil and pharynx patchy exudate, enlarged and tender of LN

Pharyngitis

ATB treatment was required only pt who suspect bacterial infection

Culture Rapid antigen-detection test Prevalence of gr A Streptococcus History of close contact

Pharyngitis

Antimicrobial therapy
Amoxicillin Cephalexin, cefuroxime Erythromycin, azithromycin Amoxicillin+clavulanate

Diseases Acute otitis media

Usual Pathogens S. pneumoniae H. influenzae M. Catarrhalis Same as above Gr A Streptococcus S. pyogenase

Treatment Amoxicillin Amoxicillin+clavulanate Cefuroxime Amoxicillin Amoxicillin+clavulanate Cefuroxime Amoxicillin Cephalexin, cefuroxime Erythromycin, Azithromycin

Acute sinusitis

Pharyngitis

Acute Bronchitis

Inflammatory conditions of the large and small elements of tracheobronchial tree The inflammatory process does not extend to the alveoli Respiratory viruses are the most common infection agents Bacterial infection causes by

Mycoplasma pneumoniae (frequent) S. pneumoniae, H. influenzae, Staphylococcal spp

Acute Bronchitis
Clinical Presentation
Cough (hallmark) Coryza, sore throat, malaise, headache Fever PE: Rhonchi or coarse, moist, bilateral rales Chest x-ray: normal

Acute Bronchitis
Antimicrobial therapy Macrolides ATB
Erythromycin Azithromycin Clarithromycin

Fluoroquinolones
Ciprofloxacin Levofloxacin

Antiviral

Influenza virus A: oseltamivir

Diseases
Acute otitis media

Usual Pathogens
S. pneumoniae H. influenzae M. Catarrhalis

Treatment
Amoxicillin Amoxicillin+clavulanate Cefuroxime Amoxicillin Amoxicillin+clavulanate Cefuroxime Amoxicillin Cephalexin, cefuroxime Erythromycin, Azithromycin Azithromycin Clarithromycin Ciprofloxacin Levofloxacin

Acute sinusitis

Same as above
Gr A Streptococcus S. pyogenase M. pneumoniae S. Pneumoniae H. influenzae

Pharyngitis

Acute Bronchitis

Microorganism gain access to LRT by

Inhaled as aerosolized particles Blood steam from extrapulmonary site Aspiration of oropharyngeal content

Community acquire pneumonia (CAP) Hospital acquire pneumonia (HAP)

Clinical presentation
Abrupt onset of fever with chill, dyspnea, productive cough PE: tachypnea, chest wall retractions and grunting respiration Diminish breath sounds Inspiratory crackles CXR: Dense lobar or segmental infiltrate

Usual Pathogens for CAP

Healthy adult

S. pneumoniae M. pneumoniae

Elderly

S. aureus
Gram-negative rod Gram-negative aerobic bacilli and S. aureus

Usual Pathogens for HAP

Usual Pathogens follows gross aspiration of gastric or oropharyngeal contents

Anerobic

bacteria

Pneumonia

Pharmacologic therapy

Antibiotic concentration in respiratory secretion in excess of pathogen MIC Blood- bronchus barrier

Molecular size (large) Lipid solubility Degree of ionization at serum and biologic fluid pH Extent of protein binding large, polar molecules Diffuse poorly into tissue and respiratory secretion

Aminoglycosides:

Pneumonia
Antimicrobial therapy
Clinical setting
CAP Healthy patients Elderly S. pneumoniae M. pneumoniae S. pneumoniae GNB: K. pneumoniae S. aureus H. influenzae Macrolides ATB Amoxicillin+clavulanate 3rd Gen cephalosporins

Usual pathogens

Presumptive therapy

Aspiration pneumonia

Mouth anaerobes

Amoxicillin+clavulanate Piperacillin+tazobactam Clindamycin

Piperacillin+tazobactam Carbapenem: imipenem 3rd Gen cephalosporins: ceftazidime , cefoperazole

HAP

GNB: K. pneumoniae, Enterobacter spp, P. Aeruginosa S. aureus