Summary
Summary Medicine Respiratory System Pharmacology
- Course
- Medicine (SCMD3000)
- Institution
- University Of The Witwatersrand (wits)
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Respiratory BlockPharmacology
Summary
Chaandanee Bhayroo
1420214
GEMP 1
,The Treatment of Respiratory Infections
Upper Respiratory Tract Infections
• Caused mostly by viruses
• <2% caused by bacteria
• Most common:
o Group A Strep pyogenes
o Strep pneumoniae
o Haemophilus influenzae
o Viridans Strep
o Moraxella catarrhalis
URTIs Microorganism Treatment
Acute sinusitis Streptococcus pneumoniae High dose amoxicillin
Otitis media Haemophilus influenza OR co-amoxiclav
OR cefuroxime/cefpodoxime
If Pen allergy:
Macrolide (erythromycin/azithromycin)
OR fluoroquinolone
(moxifloxacin/levofloxacin)
If macrolide resistant
Telithromycin
Chronic sinusitis Antibiotic treatment is not always
effective
Pharyngitis Group A β-haemolytic Strep Benzathine penicillin (single
Laryngitis pyogenes dose)/Phenoxymethylpenicillin (10 days)
Tonsillitis OR amoxicillin/co-amoxiclav
If Pen allergy
Macrolide (clarithromycin/azithromycin)
OR Cephalosporins (cefpodoxime,
cefprozil, cefuroxime)
OR Telithromycin
Epiglottitis Haemophilus influenzae 2nd or 3rd generation cephalosporin
(cefuroxime or ceftriaxone, cefotaxime)
If Pen/Cep allergy
OR Chloramphenicol (bone marrow
toxicity)
OR co-amoxiclav
Conjunctivitis Purulent conjunctivitis
- Tropical chloramphenicol (5 Days)
Severe cases
– Consider systemic therapy
No response
– Topical tobramycin
, - OR Topical ciprofloxacin
- OR Topical fusidic acid
- OR Bacitracin/polymyxin B ointment
Lower Respiratory Tract Infections
• Acute bacterial bronchitis and bacterial
pneumonia symptoms overlap
Acute bacterial bronchitis
• Less severe
• Inflammation of the airways
• Usually after a viral infection (i.e. a
secondary infection)
• Resolves on its own in a few weeks
Bacterial pneumonia
• More severe
• Infection of the lungs (alveoli fill with pus/fluid)
• Treated with antibiotics as early as possible
LRTIs Microorganisms Treatment
Acute bacterial B. pertussis Macrolide
bronchitis C. pneumoniae (clarithromycin/azithromycin/erythromycin)
M. catarrhalis OR Tetracycline (doxycycline) (> 8years)
H influenzae
M. pneumoniae
Acute exacerbation of Amoxicillin/ co-amoxiclav/ ceftriaxone
chronic bronchitis If Pen allergy
Newer fluoroquinolones
(moxifloxacin/levofloxacin)
Bacterial pneumonia Community-acquired Hospitalisation generally not needed
pneumonia - Rest, fluids & oral antibiotics
(S. pneumoniae, H. Hospitalisation
influenzae, S. aureus, K. - Patients with breathing difficulty
pneumoniae, M. - Chronic medical conditions
pneumoniae, - Age
C. pneumoniae,
Legionella sp or B. Depends on:
pertussis) - The nature of the pneumonia
Atypical or "walking“ - The causative agent (usually empiric
pneumonia treatment, based on epidemiology)
(Mycoplasma - The patient’s allergic status
pneumoniae, - The patient’s immune status
Chlamydophila - Underlying patient health, age, prior AB
pneumoniae) exposure & where treated (home, ICU,
– Symptoms similar to normal ward)
flu
, – Generally less serious - Antibiotic resistance patterns have to be
condition considered
Legionnaires’ disease
(atypical) Period of treatment: 5 – 10 days
(Legionella
pneumophila) Patients < 65 years, no co-morbidities, no
– Quite severe usage of antibiotics within prior 90 days
Community-acquired – Amoxicillin/penicillin G (benzylpenicillin)/
atypical pneumonia ampicillin
(Chlamydophila No response after 48H
pneumoniae) – Add a macrolide/azalide
- similar to walking Penicillin allergy
pneumonia - macrolide/azalide or levofloxacin,
moxifloxacin
≥ 65 years, co-morbidities, usage of
antibiotics within prior 90 days:
– Co-amoxiclav or
– 2nd or 3rd generation cephalosporin
(cefuroxime or ceftriaxone or cefotaxime)
Penicillin allergy
– Levofloxacin or moxifloxacin
Poor response after 48H
– Add a macrolide/azalide
Severe pneumonia
– Co-amoxiclav
– 2nd or 3rd generation cephalosporin (e.g.
ceftriaxone)
+
– Macrolide/azalide (e.g. clarithromycin or
azithromycin)
Penicillin allergy
– Levofloxacin or moxifloxacin
– Macrolide /azalide (e.g. clarithromycin or
azithromycin)
Atypical pneumonia
Macrolide
OR
Levofloxacin, moxifloxacin
(fluoroquinolones)
Legionella pneumophila
– Macrolide (1st line treatment)
OR
– Levofloxacin, moxifloxacin
– Beta lactams: (β-lactams not effective)
– Co-amoxiclav
OR
– Cefuroxime or ceftriaxone or cefotaxime
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