Lower Respiratory Tract Infections - PowerPoint PPT Presentation

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Lower Respiratory Tract Infections

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... Bronchitis. Acute bronchitis. COPD (aka COLD) emphysema. chronic bronchitis ... S.aureus, gram (-) enterics caused a more typical presentation of symptoms ... – PowerPoint PPT presentation

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Title: Lower Respiratory Tract Infections


1
Lower Respiratory Tract Infections
  • Jennifer Santee, Pharm.D.
  • Winter Semester 2006

2
Defining Bronchitis
  • Acute bronchitis
  • COPD (aka COLD)
  • emphysema
  • chronic bronchitis
  • acute exacerbation (AECB)
  • Differ in presentation and possible cause and
    therefore treatment

3
Organisms Possibly Involved in AECB
  • Same organisms that you might see in upper
    respiratory tract infections
  • As the patient has more severe COPD, consider
    other gram (-)s as well (for e.g. P.aeruginosa,
    K.pneumoniae)

4
Differences Between ATS and IDSA Getting a
Culture
  • What do the IDSA guidelines recommend as far as
    getting cultures?

5
Differences Between ATS and IDSA Getting a
Culture
  • ATS
  • Outpatient sputum culture and Grams stain not
    required
  • Inpatient
  • Two sets of blood cultures
  • Sputum culture if organism suspected to be
    resistant or covered by empiric therapy

6
Sings of adequate sputum sample
  • lt 10 squamous epithelial cells
  • gt 25 polymorphonuclear neutrophils (aka segs) per
    LPF

7
(No Transcript)
8
Why Are They Called Atypicals?
  • Previous thought
  • Patients with S.pneumoniae, H.influenzae,
    S.aureus, gram (-) enterics caused a more typical
    presentation of symptoms
  • Patients with other organisms such as
    M.pneumoniae and Legionella caused an atypical
    presentation
  • Current thought cant identify infecting
    organism on presentation
  • Atypical classification stuck though

9
Site of Treatment
  • Several tools to determine need for inpatient
    treatment available
  • PORT prediction rule table 3 and 4 in IDSA 2000
    guidelines
  • BTS prediction rule
  • These are not to be followed strictly, need to
    use clinical judgement as well

10
Deciding What Antibiotic to Use
  • IDSA Treat empirically first, then narrow
    spectrum based on culture results
  • ATS Treat empirically, use culture results to
    expand spectrum

11
Treating Children for CAP
  • ATS and IDSA guidelines are for adults
  • BTS does provide guidelines for treatment of
    children

12
When to Hospitalize Infants
  • O2 Sat lt or 92, cyanosis
  • RR gt 70
  • Difficulty breathing intermittent apnea,
    grunting
  • Not feeding
  • Family not able to provide outpatient care

13
When to Hospitalize Older Children
  • O2 Sat lt or 92, cyanosis
  • RR gt 50
  • Difficulty breathing grunting
  • Dehydration
  • Family not able to provide outpatient care

14
Whats Included with the Exam
  • Typical doses, routes of administration
    available, and cost of selected antibiotics
  • For amoxicillin, you will need to justify dose
  • Normal lab values
  • From IDSA guidelines tables 3 and 4
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