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Respiratory Tract Infections - Coggle Diagram
Respiratory Tract Infections
Acute bronchitis
Self-limited inflammatory process involving large & mid-sized airways
Causative organisms
90% respiratory viruses
<10% non-viral: Mycoplasma pneumoniae, Chlamydia pneumoniae, Bordetella pertusis
Diagnosis
: acute cough (>3 weeks) + normal vital signs & no signs of pneumonia on chest exam + not associated with pneumonia on CXR
Management
: antibiotics not indicated
Community acquired pneumonia (CAP)
Assessing severity
CURB-65: confusion, urea elevated (>7mmol/L), respiratory rate (>30), BP (systolic <90 or diastolic <60), age >65
[a point for each]
Aetiology
Conventional bacteria
: Strep pneumoniae (commonest), H. influenzae, Klebsiella pneumoniae, Moraxella catarrhalis, S. aureus, Salmonella spp.
Atypical bacteria
: Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella spp.
Viruses
: SARC-CoV-2, influenza, RSV, para-influenza
Other: PCP
Clinically
: acute illness & respiratory symptoms and systemic inflammation
PLUS
Radiological
: new or progressive infiltrate on CXR
Management
Severe
Ceftriaxone 1g IV daily or Co-amoxiclav 1.2g IV TDS PLUS azithromycin 500mg PO/IV daily for 3/7
Not severe
Elderly +/- co-morbid illness
Co-amoxiclav PO 1g BD 5/7
Not elderly +/- co-morbid illness
Amoxicillin PO 1g TDS 5/7
No response to initial therapy after 48 hours
All patients
Exclude empyema or lung abscess
Add macrolide
Send sputum GXP
Send blood & sputum cultures
Exclude COVID-19/influenza
HIV positive
Consider empiric therapy for PCP-pneumonia
COVID-19 pneumonia
Bacterial co-infection uncommon - 3.5%
Antibiotics used in 72% of cases
Distinctive clinical syndrome (from bacterial pneumonia)
Aspiration pneumonia
Infection is common - typically polymicrobial with oral aerobes & anaerobes
Antibiotics must cover anaerobes
Co-amoxiclav OR Penicillin/amoxicillin + metronidazole
Beta-lactam allergy: clindamycin or moxifloxacin
Initially a chemical pneumonitis occurs, which usually resolves in 48 hours
Aspiration may result in lung abscesses and/or empyema
Prolonged antibiotic therapy is needed for lung abscess with referral to surgery if there is poor response
Risk factors for aspiration: epilepsy, alcohol, bulbar weakness etc.
Bronchiectasis (infective exacerbation)
Intercurrent infections are common - further damage to airways, worsening disease, increased risk of mortality
Antibiotics
Start with narrow spectrum (e.g. amoxicillin)
Broad spectrum (e.g. co-amoxiclav) after repeated courses of antibiotics
Duration of therapy typically around 10 days
Colonisation with resistant organisms occurs late (especially Pseudomonas spp)
Sputum MC&S should be done
Important role for physiotherapy & postural drainage long term
Acute exacerbation of COPD
Acute increase in baseline dyspnoea, cough and/or sputum above the normal day-to-day variations, requiring a change in medication
Causes
Viral
(up to 50%): Rhinovirus, Parainfluenza, Coronavirus, Influenza, RSV
Bacterial
(40%): H. influenza, S. pneumoniae, M. catarrhalis, Enterobacteriaceae, P. aeruginosa
Evidence for antibiotics
Reduces treatment failure for outpatients & ICU patients
Reduces mortality for ICU patients
Leads to more adverse events than placebo
Antibiotic indications
Increased sputum purulence and increased dyspnoea or sputum volume
Requiring mechanical ventilation or admission to ICU
Vaccination
Pneumococcus, Influenza, COVID-19
Management
Mild
Oral:
Amoxicillin 500mg TDS
, alternative of Doxycycline 100mg BD [5 days]
Moderate
Oral:
Co-amoxiclav 1g BD
[5 days]
IV:
Ceftriaxone 1g daily
[5 days]
Severe
IV:
Ceftriaxone 1g daily
, alternative of Co-amoxiclav 1.2g TDS [5-7 days]