Respiratory Tract Infections
Acute bronchitis is often of viral origin. Antibiotics are indicated only if there is secondary bacterial infection.
Exacerbation ( worsening ) of chronic bronchitis
Many patients are colonized with haemophilus influenzae, Streptococcus pneumonie or Moraxella catarrhalis. (90 - 95% are beta- lactamase Producers). Hence, growth in sputum culture does not always mean infection. However, antibiotics will reduce the volume and purulence of sputum.
Treat with
- Amozicillin 500mg orally 8 hourlly for 5days or,
- Doxycillin 200mg orally 1st day, followed by 100mg daily for total five days or,
- Erythromycin 500mg orally for five days
In severe infections commence treatment with,
- Co-amoxiclav 625 mg orally 8 hourly may be considered.
Bronchitis is inflammation of the bronchi (large and medium-sized airways) in the lungs. Symptoms include coughing up mucus, wheezing, shortness of breath, and chest discomfort. Bronchitis is divided into two types: acute and chronic. Acute bronchitis is also known as a chest cold.
Acute bronchitis treatment
- Drink fluids, but avoid caffeine and alcohol.
- Get plenty of rest.
- Take over-the-counter pain relievers to reduce inflammation, ease pain, and lower your fever. ...
- Use cough medicine, if your child is age 6 or older.
- Increase the humidity in your home or use a humidifier.
Can bronchitis go away on it's own?
Most people DO NOT need antibiotics for acute bronchitis. The infection willalmost always go away on its own within 1 week. Doing these things may help you feel better: Drink plenty of fluids.
Is it dangerous to have bronchitis?
It's part of a more serious breathing disorder called chronic obstructive pulmonary disease. Chronic bronchitis is a constant irritation of the airways that has caused permanent damage to the lungs over time. Smoking is the most common cause of chronic bronchitis because of the permanent damage it can do to your lungs.
Community Acquired Pneumonia (CAP)
Community acquired pneumonia is defined as pneumonia occurring in patients who are not in hospital or were in hospital for less than 48 hours, who are not institutionalised and not significantly immunocompromised. Initially, empirical Treatment is indicated. S.pneumoniae and H.influenzae are the usual organisms causing infection.
Atypical organisms implicated include Mycoplasma pneumoniae, Legionella sp. and Chlamydia pneumoniae. Such organisms are uncommon and need not be covered with empirical treatment unless infection is judged to be severe according to accepted criteria.
Mild to moderate CAP
Children
0-3 months
Differentiate whether respiratory symptoms are due to viral or bacterial infection. Mostly symptoms in this age group are secondary to viral infections. Respiratory syncitial virus and adeno virus bronchitis are common in such age groups. In srianka rapid viral detection is not possible.
Alternative is to carry out a full blood count and a c reactive protein assay.
If the child is not ill, give symptomatic treatment without giving antibiotics until report of investigations are available.
If blood tests are strongly suggestive of infection and the child is not that unwell: treat with
Co-amoxiclav 0.25 ml/kg of 125/31 suspension orally 8 hourly.
If the child is ill with significant respiratory difficulty, start empirical antibiotics without waiting for blood investigations.
Neonates - birth to 7days
- Ampicillin 30mg/kg IV 12 hourly. Increase up to 62.5 mg/kg IV 12 hourly or,
- Cefuroxime 25 mg/kg IV 12 hourly.
Neonates - 7 days to 21 days
- Ampicillin 30mg/kg IV 8 hourly. Increase up to 62.5 mg/kg IV 8 hourly or,
- Cefuroxime 25 mg/kg IV 8 hourly.
Neonates - 21 days to 28 days
- Ampicillin 30mg/kg IV 6 hourly. Increase up to 62.5 mg/kg IV 6 hourly or,
- Cefuroxime 25 mg/kg IV 6 hourly.
3 Months to year
If the child is not ill: treat with,
- Amoxicillin 62.5 mg orally 8 hourly
If the child is ill or there is lobar infiltrate in chest X-ray
Treat with
- Ampicillin 25 mg/kg IV 6 hourly or
- Cefuroxime 125 mg IV 12 hourly
If staphylococcal infection is suspected, treat with
- Cloxacillin IV 12.5 - 50 mg/kg 6 hourly
Children 1- 5 years
If the child is not ill: treat with
- Amoxicilin 125 mg orally 8 hourly
If mycoplasma infection is suspected add
- Erythromycin 125 mg orally 6 hourlly or,
- Clarithromycin (body weight less than 8kg) 7.5mg/kg 12 hourly and (body weight 8 - 11 kg) 62.5 mg/kg orally 12 hourly.
If the child is ill or there is lobar infiltrate with or without effusion in chest X-ray treat with
- Benzylpenicillin 25 mg/kg IV 6 hourly
Children above 5 years
In mild CAP, start oral macrolides:
- Erythromycin 250 mg 6 hourly or
- Clarithromycin (body weight 12 - 19 kg) 125 mg 12 hourly and ( body weight 20 - 29 kg) 187.5mg 12 hourly.
Duration of antibiotic therapy should be 5-7 days.
Adults and children over 12 years
Mild CAP
Treat with,
- Amoxicillin 500 mg orally 8 hourly or,
- Doxyciline 200mg orally 1st day followed by 100mg orally daily or,
- Clarithromycin 250 - 500 mg Orally 12 hourly.
Duration of treatment should be 5 -7 days.
Moderate and severe cases need in hospital treatment.
Modarate CAP
Treat with benzylpenicillin plus doxyciline or clarithromycin
- Benzylpenicillin 0.6 - 1.2 g IV 6 hourly until clinical improvement, followed by amoxicillin 0.5-1 g orally 8 hourly
Plus
- Doxyxilin 200mg orally on the first day followed by 100 mg orally daily or,
- Carithromycin 250 - 500 mg orally 12 hourly or 500 mg once a day.
Svere CAP
will need in-ward treatment
- cefotaxime IV 1g 8 hourly or
- ceftraxone 1g daily
Plus
- Clarithromycin 500 mg IV 8 hourly
Source: Ministry of Health,Sri Lanka,
BNF,
Mayo clinic
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