community-acquired bacterial infections
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Community-acquired bacterial infections
The most frequent etiologic agents of bacterial tonsillitis and tonsillopharyngitis are Streptococcus pyogenes strains (80-90 %).
Initial antibiotic therapy of bacterial Initial antibiotic therapy of bacterial tonsillitis and tonsillopharyngitistonsillitis and tonsillopharyngitis
Antibiotics of I. choiceAntibiotics of I. choice– penicillin (3-4 x daily)penicillin (3-4 x daily)– macrolides (in patients with allergy to macrolides (in patients with allergy to
penicillins)penicillins)
Etiology and treatment of Etiology and treatment of peritonsillar and tonsillar abscessperitonsillar and tonsillar abscess
Etiology:– Streptococcus pyogenes– anaerobic microbes
(Peptostreptococcus sp.)
ATB of I. choice:– penicillin
Alternative ATB:– clindamycin
Pneumonia–typical –atypical
Pneumonia–community-acquired–hospital-acquired (nosocomial)
Etiology of pneumoniaEtiology of pneumonia–typical pneumonia
Streptococcus pneumoniae Haemophilus influenzae Moraxella (Branhamella) catarrhalisStaphylococcus aureusKlebsiella pneumoniaeother
Etiology of pneumoniaEtiology of pneumonia
atypical pneumoniaatypical pneumonia Chlamydophila pneumoniaeChlamydophila pneumoniaeChlamydophila psittaciChlamydophila psittaciMycoplasma pneumoniaeMycoplasma pneumoniaeLegionella pneumophilaLegionella pneumophilaothersothers
According the data from According the data from olomouc region it is possible olomouc region it is possible
to make a conclusion:to make a conclusion:
typical pneumonias form about 65 %
atypical pneumonias form about 35 %– chlamydia pneumonias 24 % – mycoplasma pneumonias 11 %
Etiology of pneumonia Etiology of pneumonia in children in children
Haemophilus influenzaeMycoplasma pneumoniae
(mainly in children 5 years old and older)
Streptococcus pneumoniaeKlebsiella pneumoniae
According the data from olomouc According the data from olomouc region it is possible to make a region it is possible to make a
conclusion (etiology of conclusion (etiology of pneumonia in children):pneumonia in children):
–Haemophilus influenzae 36 %–Mycoplasma pneumoniae 25 %–Klebsiella pneumoniae 14 %–Streptococcus pneumoniae 11 %–others 14 %
Initial antibiotic therapy of Initial antibiotic therapy of community-acquired pneumoniacommunity-acquired pneumonia
Drug ofDrug of I. I. choicechoice
– amoxicilamoxicilllinin
Alternative antibioticsAlternative antibiotics
– mamaccrolidrolideses ( (e.g. ce.g. claritlarithhromycinromycin, azithromycin, azithromycin))
– doxycycline (in adults and children older than 12 years)doxycycline (in adults and children older than 12 years)
Etiology and treatment of Etiology and treatment of otitis media acutaotitis media acuta
Etiology:– Streptococcus
pneumoniae– Haemophilus influenzae– Moraxella (B)
catarrhalis
Antibiotic of I. choice:– amoxicillin
Alternative antibiotic:– amoxicillin/clavulanic acid– ampicillin/sulbactam– cephalosporins II. gen.
(cefuroxime, cefprozil)– in patients with allergy to
penicilllins - macrolides
Etiology and treatment of Etiology and treatment of otitis media chronicaotitis media chronica
Etiology:– gram-negative rods
(Proteus sp., Pseudomonas aeruginosa)
– Staphylococcus aureus– anaerobic microbes
ATB of I. choice:– fluorochinolones (ofloxacin,
ciprofloxacin)
Alernative ATB:– gentamicin– ceftazidime– gentamicin+ceftazidime
Etiology and treatment of sinusitis acutaEtiology and treatment of sinusitis acuta
Etiology:– Streptococcus
pneumoniae Haemophilus influenzae
– Moraxella (B) catarrhalis
Antibiotic of I. choice:– amoxicillin
Alternative antibiotic:
– amoxicillin/clavulanic acid
– ampicillin/sulbactam
– cephalosporins II. gen. (cefuroxime,
cefprozil)
– in patients with allergy to penicilllins -
macrolides
Etiology and treatment of Etiology and treatment of epiglottitisepiglottitis
Etiology:– Haemophilus
influenzae type b
ATB of I. choice:– cephalosporins of III. generation– ampicillin– amoxicilin/clavulanic acid– ampicillin/sulbactam– cefuroxime
Alternative ATB:– chloramfenikol
(in case of allergy to penicillins)
Etiology of community-acquired Etiology of community-acquired urinary tract infectionsurinary tract infections
Escherichia coli
Proteus mirabilis
Enterococcus faecalis
Streptococcus agalactiae
others
Initial antibiotic therapy of community-Initial antibiotic therapy of community-acquired urinary tract infectionsacquired urinary tract infections
Drug of I. choiceDrug of I. choice– nitrofurantoin, cotrimoxazol, trimethoprim, nitrofurantoin, cotrimoxazol, trimethoprim,
amoxicillin, oxolinic acidamoxicillin, oxolinic acid
Alternative antibioticsAlternative antibiotics– amoxicillin/clavulanic acidamoxicillin/clavulanic acid– ampicillin/sulbactamampicillin/sulbactam– cephalosporins II. gen. (cefuroxime, cefprozil)cephalosporins II. gen. (cefuroxime, cefprozil)
Hospital-acquired Hospital-acquired bacterial infectionsbacterial infections
Therapy in early-onset Therapy in early-onset hospital-acquired pneumoniahospital-acquired pneumonia
ampicillin/sulbactam
or
amoxicillin/clavulanic acid
event. + gentamicin
Therapy in late-onset Therapy in late-onset hospital-acquired pneumoniahospital-acquired pneumonia
carbapenem (imipenem, meropenem)or
piperacillin-tazobactam
event. + aminoglycoside
Etiologic agents of HAP in ICUs Etiologic agents of HAP in ICUs (University Hospital Olomouc)(University Hospital Olomouc)
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