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Community-acquired bacterial infectionsbacterial infections
�The most frequent etiologic agent of bacterial tonsillitis and tonsillopharyngitis is Streptococcus pyogenesStreptococcus pyogenes
(80-90 %)
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))
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
24
33
1720
25
30
35
resi
stan
ce in
%
10
12
14
16
18
usa
ge
of m
acro
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in %
resistanceusage of macrolides
Urbánek K, Kolář M, Čekanová L. Pharmacy World and Science. 2005, 27:104-107.
except patients with allergy to penicillins
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9,2
1415
0
5
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15
1997 1998 1999 2000 2001 2002 2003
resi
stan
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%
0
2
4
6
8
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ge
of m
acro
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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
�Pneumonia–typical pathogens–atypical pathogens
�Pneumonia–community-acquired–hospital-acquired (nosocomial)
Etiology Etiology ofof communitycommunity--acquiredacquiredpneumoniapneumonia
–typical pathogens �Streptococcus pneumoniae �Haemophilus influenzae �Haemophilus influenzae �Moraxella (Branhamella) catarrhalis�Staphylococcus aureus�Klebsiella pneumoniae�other
Etiology Etiology ofof communitycommunity--acquiredacquiredpneumoniapneumonia
–atypical pathogens�Chlamydophila pneumoniaeChlamydophila pneumoniae�Chlamydophila psittaci�Mycoplasma pneumoniae�Legionella pneumophila�others
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 %
Etiology Etiology ofof pneumoniapneumoniain in childrenchildren
�Haemophilus influenzae
�Mycoplasma pneumoniae (mainly in children 5 years old and older)
�Streptococcus pneumoniae
�Klebsiella pneumoniae
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 %
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)
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%
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
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
BacterialBacterial etiology etiology ofof acuteacute sinusitissinusitisin in olomoucolomouc regionregion
Streptococcuspneumoniae- 61%
Moraxella (B)catarrhalis- 5%
others - 12%
Haemophilus influenzae- 22%
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
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)
Etiology Etiology ofof communitycommunity--acquiredacquiredurinaryurinary tracttract infectionsinfections
�Escherichia coli
�Proteus mirabilisProteus mirabilis
�Enterococcus faecalis
�Streptococcus agalactiae
�others
Bacterial etiology of community-acquired urinary tract infections in olomouc region
E.faecalis9%
S.agalactiae8%
others4%
E.coli68%
P.mirabilis11%
9%
ResistanceResistance ofof E. E. colicoli to to antibioticsantibiotics((olomoucolomouc region, in %)region, in %)
TheThe developmentdevelopment ofof EscherichiaEscherichia colicoli resistanceresistancetoto ofloxacinofloxacin inin 19919977 -- 20020022 ((olomoucolomouc regionregion))
6
8
10
12
pro
cen
to r
ezis
ten
ce
0,5
0,6
0,7
0,8
0,9
1
DD
D/1
000/
den
rezistence k ofloxacinu
spotřeba fluorochinolonů
0
2
4
6
1997 1998 1999 2000 2001 2002
pro
cen
to r
ezis
ten
ce
0
0,1
0,2
0,3
0,4
0,5
DD
D/1
000/
den
Urbánek K, Kolář M, Strojil J, et al. Pharmacoepidemiology and Drug Safety. 2005, 14:741-745.
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)
HospitalHospital--acquiredacquiredbacterialbacterial infectionsinfections
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.
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
EtiologicEtiologic agentsagents ofof HAP in HAP in ICUsICUs(University (University HospitalHospital Olomouc)Olomouc)
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