atb therapy - lf
TRANSCRIPT
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Community-acquired bacterial infectionsbacterial infections
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�The most frequent etiologic agent of bacterial tonsillitis and tonsillopharyngitis is Streptococcus pyogenesStreptococcus pyogenes
(80-90 %)
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InitialInitial antibioticantibiotic therapytherapy ofof bacterialbacterialtonsillitistonsillitis andand tonsillopharyngitistonsillopharyngitis
��AntibioticsAntibiotics ofof I. I. choicechoice––penicillinpenicillin (3(3--4 x 4 x dailydaily))––penicillinpenicillin (3(3--4 x 4 x dailydaily))––macrolidesmacrolides(in (in patientspatientswithwith allergyallergyto to penicillinspenicillins))
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TheThe developmentdevelopment ofof StreptococcusStreptococcus pyogenespyogenes resistanceresistancetoto eryterythhromycinromycin inin 19919977 -- 20020033 ((olomoucolomouc regionregion))
The drug of I. choice in bacterial tonsillitis and tonsillopharyngitis is penicillin, except patients
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Urbánek K, Kolář M, Čekanová L. Pharmacy World and Science. 2005, 27:104-107.
except patients with allergy to penicillins
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Etiology Etiology andand treatmenttreatment ofofperitonsillarperitonsillar andand tonsillartonsillar abscessabscess
�Etiology:– Streptococcus pyogenes
– anaerobic microbes
�ATB of I. choice:– penicillin
– anaerobic microbes (Peptostreptococcussp.)
�Alternative ATB:– clindamycin
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�Pneumonia–typical pathogens–atypical pathogens
�Pneumonia–community-acquired–hospital-acquired (nosocomial)
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Etiology Etiology ofof communitycommunity--acquiredacquiredpneumoniapneumonia
–typical pathogens �Streptococcus pneumoniae �Haemophilus influenzae �Haemophilus influenzae �Moraxella (Branhamella) catarrhalis�Staphylococcus aureus�Klebsiella pneumoniae�other
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Etiology Etiology ofof communitycommunity--acquiredacquiredpneumoniapneumonia
–atypical pathogens�Chlamydophila pneumoniaeChlamydophila pneumoniae�Chlamydophila psittaci�Mycoplasma pneumoniae�Legionella pneumophila�others
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AccordingAccording thethe data data fromfrom olomoucolomoucregion region itit isis possiblepossible to to makemake a a
conclusionconclusion::
�typical pathogens form about 65 %
�atypical pathogens form about 35 %�atypical pathogens form about 35 %–chlamydia pneumonias 24 %
–mycoplasma pneumonias 11 %
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Etiology Etiology ofof pneumoniapneumoniain in childrenchildren
�Haemophilus influenzae
�Mycoplasma pneumoniae (mainly in children 5 years old and older)
�Streptococcus pneumoniae
�Klebsiella pneumoniae
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AccordingAccording thethe data data fromfrom olomoucolomoucregion region itit isis possiblepossible to to makemake a a
conclusionconclusion (etiology (etiology ofof pneumoniapneumoniain in childrenchildren):):
–Haemophilus influenzae 36 %–Mycoplasma pneumoniae 25 %–Klebsiella pneumoniae 14 %–Streptococcus pneumoniae 11 %–others 14 %
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InitialInitial antibioticantibiotic therapytherapy ofofcommunitycommunity--acquiredacquired pneumoniapneumonia
�Drug of I. choice
– amoxicillin
�Alternative antibiotics
– macrolides (e.g. clarithromycin, azithromycin)
– doxycycline (in adults and children older than 12
years)
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BacterialBacterial etiology etiology ofof acuteacute otitis media otitis media in in olomoucolomouc regionregion
Streptococcus pneumoniae- 49%
Moraxella (B)catarrhalis
others - 16%
Haemophilus influenzae- 21%
catarrhalis- 14%
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Etiology Etiology andand treatmenttreatment ofofotitis media otitis media acutaacuta
�Etiology:– Streptococcus
pneumoniae
Haemophilus
� Antibiotic of I. choice:– amoxicillin
� Alternative antibiotic:– Haemophilus
influenzae
– Moraxella (B) catarrhalis
� Alternative antibiotic:– amoxicillin/clavulanic acid– ampicillin/sulbactam– cephalosporins II. gen.
(cefuroxime, cefprozil)– in patients with allergy to
penicilllins - macrolides
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Etiology Etiology andand treatmenttreatment ofofotitis media otitis media chronicachronica
�Etiology:– gram-negative rods
(Proteusspp.,
� ATB of I. choice:– fluorochinolones
(ofloxacin, ciprofloxacin)(Proteusspp., Pseudomonas aeruginosa)
– Staphylococcus aureus
– anaerobic microbes
� Alernative ATB:– gentamicin
– ceftazidime
– gentamicin+ceftazidime
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BacterialBacterial etiology etiology ofof acuteacute sinusitissinusitisin in olomoucolomouc regionregion
Streptococcuspneumoniae- 61%
Moraxella (B)catarrhalis- 5%
others - 12%
Haemophilus influenzae- 22%
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Etiology Etiology andand treatmenttreatment ofof sinusitissinusitis acutaacuta
�Etiology:– Streptococcus
pneumoniae Haemophilus influenzae
� Antibiotic of I. choice:– amoxicillin
� Alternative antibiotic:
– amoxicillin/clavulanic acidinfluenzae– Moraxella (B)
catarrhalis
– amoxicillin/clavulanic acid
– ampicillin/sulbactam
– cephalosporins II. gen.
(cefuroxime, cefprozil)
– in patients with allergy to
penicilllins - macrolides
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Etiology Etiology andand treatmenttreatment ofofepiglottitisepiglottitis
�Etiology:– Haemophilus
influenzae type b
� ATB of I. choice:– cephalosporins of III. generation
– ampicillin
– amoxicilin/clavulanic acid– amoxicilin/clavulanic acid
– ampicillin/sulbactam
– cefuroxime
� Alternative ATB:– chloramfenikol
(in case of allergy to penicillins)
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Etiology Etiology ofof communitycommunity--acquiredacquiredurinaryurinary tracttract infectionsinfections
�Escherichia coli
�Proteus mirabilisProteus mirabilis
�Enterococcus faecalis
�Streptococcus agalactiae
�others
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Bacterial etiology of community-acquired urinary tract infections in olomouc region
E.faecalis9%
S.agalactiae8%
others4%
E.coli68%
P.mirabilis11%
9%
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ResistanceResistance ofof E. E. colicoli to to antibioticsantibiotics((olomoucolomouc region, in %)region, in %)
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TheThe developmentdevelopment ofof EscherichiaEscherichia colicoli resistanceresistancetoto ofloxacinofloxacin inin 19919977 -- 20020022 ((olomoucolomouc regionregion))
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Urbánek K, Kolář M, Strojil J, et al. Pharmacoepidemiology and Drug Safety. 2005, 14:741-745.
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InitialInitial antibioticantibiotic therapytherapy ofof communitycommunity--acquiredacquired urinaryurinary tracttract infectionsinfections
�Drug of I. choice– nitrofurantoin, cotrimoxazol, trimethoprim,
(amoxicillin, oxolinic acid)(amoxicillin, oxolinic acid)
�Alternative antibiotics– amoxicillin/clavulanic acid
– ampicillin/sulbactam
– cephalosporins II. gen. (cefuroxime, cefprozil)
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HospitalHospital--acquiredacquiredbacterialbacterial infectionsinfections
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Therapy in earlyTherapy in early--onset onset hospitalhospital--acquired pneumoniaacquired pneumonia
Potential pathogen Recommended antibiotic
Streptococcus pneumoniae
ampicillin/sulbactamor
Haemopilus influenzae
Staphylococcus aureus methicillin- oramoxicillin/clavulanic
acid
event. + gentamicin
Staphylococcus aureus methicillin-sensitive
Antibiotic-susceptible Escherichia coli Klebsiella pneumoniaeEnterobacter spp.
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Therapy in lateTherapy in late--onset onset hospitalhospital--acquired pneumoniaacquired pneumonia
Potential pathogens Antibiotic therapy
Multidrug-resistant pathogensPseudomonas
carbapenem (imipenem, meropenem)or
β-lactam/β-lactamase inhibitor Pseudomonas aeruginosaKlebsiella pneumoniae(ESBL+) Acinetobacter spp.
β-lactam/β-lactamase inhibitor (piperacillin-tazobactam)
event. + aminoglycoside
(amikacin, gentamicin, tobramycin)
MRSA linezolid or vancomycin
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EtiologicEtiologic agentsagents ofof HAP in HAP in ICUsICUs(University (University HospitalHospital Olomouc)Olomouc)