1 / 15

Community-acquired Pneumonia

HKCEM College Tutorial. Community-acquired Pneumonia. Author Dr. Shek Kam Chuen Oct 2013. History. M/39 Good past health Fever one day, 38.8 o C Cough with yellowish sputum Right pleuritic chest pain. Any other important history?. FTOCC Travel: Middle East, Avian flu

sally
Download Presentation

Community-acquired Pneumonia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. HKCEM College Tutorial Community-acquired Pneumonia Author Dr. Shek Kam Chuen Oct 2013

  2. History • M/39 • Good past health • Fever one day, 38.8oC • Cough with yellowish sputum • Right pleuritic chest pain

  3. Any other important history? • FTOCC • Travel: Middle East, Avian flu • Occupation: virus laboratory worker, poultry worker, work in wet market • Contact: Poultry contact or index case • Cluster: any, ?Amoy Garden in 2003 March

  4. Case one: CAP Out-patient Tx • FTOCC –ve • What is clinical diagnosis? • CAP, clinically stable • What antibiotics shall we give? • What are the common pathogens in HK?

  5. Bacterial Atypical Viral What are possible pathogens?

  6. Community Acquired Pneumonia • Local pathogens in order of commonest: • Haemophilus influenzae(13.7%-60%) • Streptococcus pneumoniae • Moraxella catarrhalis • Chlamydia pneumoniae • Legionella • Mycoplasma • Not to forget TB (esp elderly) or viral agents • Local A&E sputum culture (QEH & PMH) data suggests H. influenzae is much more common than S. pneumoniae. Big 3 Atypical

  7. Subsequent treatment Augmentin 1g BD 1/52 +Azithromycin 500mg daily for 3/7 Sputum CST + AFB CST saved Follow up in 5/7

  8. What are components of Augmentin? • β-lactam/β-lactamase inhibitors combinations • Amoxicillin-clavulanate (Augmentin) • MSSA, • S. pneumoniae, • H. influenzae, • M. catarrhalis, • some E-coli, anaerobes • 1. Augmentin 375mg tds =(amoxil250 +clavulanate125)x3 =amoxil750 + clavunanate375/D • 2. Augmentin 375+ amoxil250 tid =amoxil1500 +clavunanate375 /D • 3. Augmentin 1 gm bd =(amoxil 875+caluvulanate 125)x2 =amoxil1750+calvunanate250/D

  9. Why Azithromycin added? • Macrolides are good at CAP atypical agents and campylobacter(GE). • Newer macrolides (clarithromycin, azithromycin) have a better coverage of H. influenzae. But there are wide spread resistance among the common Gram-positive bacteria including MSSA, Pneumococcus, Group A Streptococcus. • not be used as single empirical treatment of CAP and soft tissue infections to substitute penicillin in penicillin-allergy patients

  10. At Follow-Up,Afebrile for 3 days, Feel better but still cough, CXR: more or less the same Sputum grew: • Streptococcus Pneumoniae • Levofloxacin: S • Penicillin (CNS): R • Penicillin (non CNS): S • Vancomycin : S

  11. A. levofloxacin 500mg daily x 7 days B. iv vancomycin C. Change Klacid 500mg BD 1/52 D. Continue high dose Augmentin E. Consult microbiologist whether the S. Pneumoniae is S to Augmentin What is subsequent MX? Ans D

  12. First line Antibiotics for CAP • Higher dose Augmentin or Unasyn in view of drug resistant S. Pneumoniae DRSP infection Augmentin 1gm BD or (Augmentin 375mg tds + amoxycillin 250mg tds) + Azithromycin(Zithromax) is preferred in view of no major drug interaction 9 Clarithromycin (Klacid) is P-450 cytochrome inhibitor with multiple drug interactions

  13. What is the role Fluoroquinolones? • Fluoroquinolone inhibit DNA gyrase and useful in G+ve and G-ve bacteria. But the resistance is increasing. • Not for 1st line for CAP in HK • Which quinolones? • Levofloxacin is more potent than ciproxin against S. Pneumoniae

  14. Fluoroquinolones are used as second line for CAP • for adults when the first line regime is failed • Allergic to alternative agents • Documented infection due to pneumococci with high level penicillin resistance (Penicillin MIC >=4UG /mL.) • (it is not used as first line since it may mask TB and may cause drug resistance in future.) • levofloxacin 750mg QD for 5/7 because it is concentration dependent. Impact CID 2007;44 (Suppl 2) S27-S72

  15. Thank You

More Related