This document discusses respiratory tract infections, specifically focusing on infections of the upper respiratory tract. It defines otitis media as an inflammation of the middle ear and describes its three subtypes. Otitis media is common, especially in young children, and can be caused by bacteria like Streptococcus pneumoniae that enter the middle ear following a viral upper respiratory infection. Symptoms include ear pain, fever, and hearing loss. The document also discusses acute bacterial rhinosinusitis, noting that it is commonly caused by the same bacteria as otitis media and that differentiating between viral and bacterial infections is important to avoid overprescribing antibiotics.

1. RESPIRATORY TRACT
INFECTIONS
Dr. Kainat Panjwani, PharmD
Assistant Professor
Pharmacotherapeutics II
MLR Institute of Pharmacy

2. Definition
Respiratory tract is the passage formed by the mouth, nose, throat, and lungs,
through which air passes during breathing, consisting especially of the nose, nasal
passages, pharynx, larynx, trachea, bronchi, and lungs.
Respiratory tract infection refers to any of a number of infectious diseases involving
the respiratory tract. An infection of this type is normally further classified as an upper
respiratory tract infection (URTI) or a lower respiratory tract infection (LRTI).

3. UPPER RESPIRATORY TRACT
INFECTIONS

4. OTITIS MEDIA
 Otitis Media is defined as an inflammation
of the middle ear i.e., the area between
the tympanic membrane and the inner
ear.
 There are three subtypes of otitis media:
1. acute otitis media,
2. otitis media with effusion, and
3. chronic otitis media.
 The three are differentiated by (a) acute
signs of infection, (b) evidence of middle
ear inflammation, and (c) presence of
fluid in the middle ear.

5. 1. Acute otitis media involves the rapid onset of signs and symptoms of
inflammation in the middle ear that manifests clinically as one or more of the
following:
 otalgia (denoted by pulling of the ear in some infants)
 hearing loss
 fever, or
 irritability.
2. Otitis media with effusion (accumulation of liquid in the middle ear cavity) differs
from acute otitis media in that signs and symptoms of an acute infection are
absent.

6. EPIDEMIOLOGY
• There are more than 709 million cases of otitis media worldwide each year; half of these
cases occur in children under 5 years of age.
• Otitis media is a global problem and is found to be slightly more common in males than in
females.
• The specific number of cases per year is difficult to determine due to the lack of reporting
and varied incidence across many different geographical regions.
• The peak incidence of otitis media occurs between six and twelve months of life and
declines after age five.
• Approximately 80% of all children will experience a case of otitis media during their lifetime
and between 80% and 90% of all children will have otitis media with an effusion before
school age.
• Otitis media is less common in adults than in children, unless it occurs in
immunocompromised adults.

7. RISK FACTORS FOR OTITIS MEDIA
 Winter season/outbreaks of respiratory syncytial or influenza virus
 Attendance at day care centers
 Lack of breast-feeding in infants
 Early age of first diagnosis
 Nasopharyngeal colonization with middle ear pathogens
 Genetic predisposition
 Siblings in the home
 Lower socioeconomic status
 Exposure to tobacco smoke
 Use of a pacifier
 Male gender
 Immunodeficiency
 Allergy

8.  ETIOLOGY
 S. pneumoniae
 Haemophilus influenzae
 Moraxella catarrhalis
 PATHOPHYSIOLOGY
 Acute bacterial otitis media usually follows a viral upper respiratory tract infection
that causes eustachian tube dysfunction and mucosal swelling in the middle ear.
 Bacteria that colonize the nasopharynx thus enter the middle ear and are not
cleared properly by the mucociliary system.
 Abnormal function of the eustachian tube can cause reflux transudation of liquid in
the middle ear and proliferation of bacteria, resulting in acute otitis media.

9. Due to etiological factor(URTI, Bacteria)
Exudates & edema in middle ear
Decrease retraction of tympanic membrane
Serous exudates in middle ear
Pus formation
Tympanic membrane rupture
ACUTE OTITIS MEDIA

10. Stages
1. Catarrhal stage: is characterized by occlusion of
Eustachian tube and congestion of middle ear.
2. Stage of exudation: Exudate collects in the middle ear
and ear drum is pushed laterally. Initially the exudate
is mucoid, later it becomes purulent.
3. Stage of suppuration: Pus in the middle ear collects
under tension, stretches the drum & perforates it by
pressure necrosis & the exudate starts escaping into
external auditory canal
4. Stage of healing: The infection starts resolving from
any of the stages mentioned & usually clears up
completely without leaving any sequelae.
5. Stage of complications: Infection may spread to the
mastoid antrum. Initially it causes Catarrhal mastoiditis
[congestion of the mastoid mucosa], stage of
Coalescent mastoiditis & later empyema of the
mastoid.

13. Clinical Presentation of Acute Otitis Media
The acute onset of signs and symptoms of middle ear
infection following cold symptoms of runny nose,
nasal congestion, or cough.
 Signs and symptoms
o Pain that can be severe (more than 75% of patients)
o Children may be irritable, tug on the involved ear,
and have difficulty sleeping
o Fever is present in less than 25% of patients and,
when present, occurs more often in younger children
o Examination shows a discolored (gray), thickened,
bulging eardrum
o Pneumatic otoscopy or tympanometry demonstrates
an immobile eardrum; 50% of cases are bilateral.
o Draining middle ear fluid occurs (less than 3% of
patients) that usually reveals a bacterial etiology.

14. •Otalgia (not always!)
•Fever
•Hearing loss (speech delay in
children)
•Headache
•Nausea
•Rhinitis
•Cough
•Conjunctivitis

15. DIAGNOSTIC TESTS
 Laboratory Studies – sepsis workup (gram staining, culture & sensitivity)
 Imaging - study of choice is a contrast-enhanced CT scan of the temporal bones
 MRI is more helpful in depicting fluid collections
 Tympanometry may help with diagnosis in patients with OM with effusion
Diagnostic criteria for OM:
 Bulging TM
 Retracted TM
 Impaired mobility of the TM
 Loss of light reflex
 Erythematous TM
 Purulent otorrhea
 Opacification of the TM

16. TREATMENT
First Line Second Line (10 day
course)
Third Line
Amoxicillin high dose
80-90 mg/kg/day
Divided twice daily.
If Penicillin Allergy, use
Macrolide (e.g.
Azithromycin)
1. Amoxicillin with
clavulanate
90 mg/kg/day divided twice
daily for 10 days
2. Cefuroxime
30 mg/kg/day divided twice
daily for 10 days
3. Cefprozil
30 mg/kg/day divided twice
daily for 10 days
4. Cefdinir
14 mg/kg/day divided one
to two times daily fo 10
days
5. Cefpodoxime
30 mg/kg once daily for 10
days
1. Strongly consider
Tympanocentesis for
bacterial culture.
2. Ceftriaxone
50 mg/kg IM daily for 3
days
3. Clindamycin
30-40 mg/kg/day divided
four times daily for 10
days.

17. Penicillin allergy
1. Consider Tympanocentesis
2. Clindamycin 30-40 mg/kg/day (max 1800 mg) divided four times daily for 10 days
3. Macrolide antibiotics (High bacterial resistance rate)
1. Clarithromycin 15 mg/kg/day divided twice daily for 10 days
2. Erythromicin 30-50mg/kg every 6-8 hours
3. Azithromycin
1. One dose of Azithromycin at 30 mg/kg (up to 1500 mg) or
2. Three days of Azithromycin at 20 mg/kg/day once daily (up to 500 mg/day) or
3. Azithromycin 10 mg/kg (max: 500 mg) day 1, then 5 mg/kg/day (max 250
mg) for 5 days
4. Fluoroquinolones (avoid under age 16 years)
1. Gatifloxacin
2. Levofloxacin
3. Moxifloxacin

18. ACUTE BACTERIAL
RHINOSINUSITIS

19. SINUSES
 They are hollow, airfilled cavities that are lined
by respiratory mucosa “pseudostratified
ciliated columnar epithelium”
 There are four pairs of paranasal sinuses;
The frontal sinuses are located above the eyes,
in the frontal bone
The maxillary sinuses are located in the
cheekbones, under the eyes.
The ethmoid sinuses(6 – 10 per side), also
called ethmoid labyrinth are located between
the eyes and the nose.
The sphenoid sinuses(2) are located in the
body of sphenoid bone, behind the nose and
the eyes.

20. DEFINITION
 Sinusitis is an inflammation and/or infection of the paranasal
sinuses, or membrane-lined air spaces, around the nose.
 The term rhinosinusitis is now preferred because sinusitis
typically also involves the nasal mucosa.
 Even though the majority of rhinosinusitis infections are viral
in origin, antibiotics are frequently prescribed.
 It is thus important to differentiate between viral and bacterial
rhinosinusitis to avoid antibiotic overuse.

21. EPIDEMIOLOGY
 Nearly 30 million cases of rhinosinusitis are diagnosed annually in USA.
 Acute bacterial rhinosinusitis is overdiagnosed; thus, antibiotics are
overprescribed.
 Most rhinosinusitis infections have a viral etiology, and yet, antibiotics are
frequently prescribed.
 Adults with rhinosinusitis miss an average of 6 workdays/y with these
infections.
 Patients with rhinosinusitis are significantly more likely to use the
emergency room, spend more than $500/y on medical care, and see a
medical specialist.

22. ETIOLOGY
 Acute bacterial rhinosinusitis is caused, most often, by the same bacteria implicated in acute
otitis media: S. pneumoniae and H. influenzae.
 These organisms are responsible for approximately 50% to 70% of bacterial causes of acute
bacterial rhinosinusitis in both adults and children.
 M. catarrhalis is also sometimes implicated in adults and children (approximately 8%-16%).
 Streptococcus pyogenes, Staphylococcus aureus, gram-negative bacilli, and anaerobes are
associated less frequently with acute bacterial rhinosinusitis.
 Issues of bacterial resistance are similar to those found with acute otitis media.

23. PATHOPHYSIOLOGY
Mucosal edema resulting from a viral rhinosinusitis
obstruction of natural ostia
hypoxygenation
acidosis
vasodilation
increased secretion by goblet cells
ciliary dysfunction with poor mucous quality
retention of secretion and predisposition to bacterial infection.

25. CLINICAL PRESENTATION
 Acute bacterial sinusitis in adults most often
manifests with more than 7 days of nasal
congestion, purulent rhinorrhea, postnasal
drip, and facial pain and pressure, alone or
with associated referred pain to the ears and
teeth.
 There may be a cough, often worsening at
night.
 Children with acute sinusitis might not be able
to relay a history of postnasal drainage or
headaches, so cough and rhinorrhea are the
most commonly reported symptoms.
 Other symptoms can include fever, nausea,
fatigue, impairments of smell and taste, and
halitosis.

26. Symptoms Associated with the Diagnosis of Chronic
Sinusitis
 Facial pain or pressure
 Facial congestion or fullness
 Nasal obstruction or blockage
 Nasal discharge, purulence, or postnasal drip
 Hyposmia or anosmia
 Headache
 Fever
 Halitosis
 Fatigue
 Dental pain
 Cough
 Ear pain, pressure, fullness

27. DIAGNOSIS
 In a primary care setting, a good history and physical examination to detect the presence of
most or all of the commonly manifesting signs and symptoms can provide a reliable diagnosis
of acute sinusitis. The presence of purulent secretions has the highest positive predictive
value for diagnosing sinusitis clinically.
 CT scan

28.  Transillumination - A common practice before plain radiographs and CT scans
were widely available, transillumination is of limited use and has a high rate of
error.
 Ultrasonography - Ultrasonography has not been proved accurate enough to
substitute for a radiographic evaluation. However, it may be considered to confirm
sinusitis in pregnant women, for whom radiographic studies could pose a risk.
 Nasal Smear - By examining the cellular contents of the nasal secretions, one
might find polymorphonuclear cells and bacteria in sinusitis. In a viral infection,
these would not be found, and in allergic disease, one would expect to find
eosinophils.
 Sinus Puncture
 The most accurate way to determine the causative organism in sinusitis is a sinus
puncture. After anesthetization of the puncture site, the contents of the maxillary
sinus are aspirated under sterile technique, and bacterial cultures are performed to
identify the organism. Culture specimens obtained from nasal swabs correlate
poorly with sinus pathogens found by puncture because of contamination of the
swab with normal nasal flora. However, because sinus puncture is an invasive
procedure, it is not routinely performed.

30. Treatment of Acute Sinusitis
 Antibiotics, such as amoxicillin for 2 weeks, have been the recommended first-line
treatment of uncomplicated acute sinusitis. The antibiotic of choice must cover S.
pneumoniae, H. influenzae, and M. catarrhalis. Because rare intracranial and orbital
complications of acute bacterial sinusitis are caused by S. pneumoniae (most
commonly in the immunocompromised host), adequate coverage for this organism is
important. Amoxicillin-clavulanate (Augmentin) is also an appropriate first-line
treatment of uncomplicated acute sinusitis. The addition of clavulanate, a beta-
lactamase inhibitor, provides better coverage for H. influenzae and M. catarrhalis.
 Because of S. pneumoniae resistance, higher doses of amoxicillin (90 mg/kg/day to a
maximum of 2 g/day) should be considered. These higher doses are effective
against S. pneumoniae because resistance is related to alteration in penicillin-binding
proteins, a mechanism distinct from the beta-lactamase enzymatic inactivation of H.
influenzae and M. catarrhalis.

31.  Other options include cephalosporins such as cefpodoxime proxetil (Vantin) and
cefuroxime (Ceftin). In patients allergic to beta-lactams, trimethoprim-
sulfamethoxazole (Bactrim), clarithromycin (Biaxin), and azithromycin (Zithromax)
may be prescribed but might not be adequate coverage for H. influenzae or
resistant S. pneumoniae.
 Penicillin, erythromycin (Suprax), and first-generation cephalosporins such as
cephalexin (Keflex, Keftab) are not recommended for treating acute sinusitis
because of inadequate antimicrobial coverage of the major organisms.
 If treatment with one of these first-line agents has not shown a clinical response
within 72 hours of initial therapy, more broad-spectrum antibiotics should be
considered. These include the fluoroquinolones, gatifloxacin (Tequin), moxifloxacin
(Avelox), and levofloxacin (Levaquin), especially if amoxicillin-clavulanate,
cefpodoxime proxetil, and cefuroxime were previously prescribed.

32. Treatment of Chronic Sinusitis
 Antibiotic therapy for chronic sinusitis is controversial and may be most appropriate
for acute exacerbation of chronic sinusitis. Medical therapy should include both a
broad-spectrum antibiotic and a topical intranasal steroid to address the strong
inflammatory component of this disease. Antibiotic therapy might need to be
continued for 4 to 6 weeks.
 The antibiotics of choice include agents that cover organisms causing acute
sinusitis but also cover Staphylococcus species and anaerobes. These include
amoxicillin-clavulanate, cefpodoxime proxetil, cefuroxime, gatifloxacin,
moxifloxacin, and levofloxacin. Currently used topical intranasal steroids such as
fluticasone (Flonase), mometasone (Nasonex), budesonide (Rhinocort AQ), and
triamcinolone (Nasacort AQ) have a favorable safety profile and indications for the
pediatric age group. A short course of oral steroids may be used for extensive
mucosal thickening and congestion or nasal polyps.

33.  Adjunctive Therapy
 To temporarily alleviate the drainage and congestion associated with sinusitis,
decongestant nasal sprays oxymetazoline (Afrin) and phenylephrine hydrochloride
(Neo-Synephrine) may be used for 3 to 5 days. Long-term use of topical
decongestants can cause rhinitis medicamentosa, which is rebound congestion
caused by vasodilatation and inflammation. Oral decongestants
(pseudoephedrine) may be a reasonable alternative if the patient has no
contraindication such as hypertension. Mucolytic agents (guaifenesin) can help to
decrease the viscosity of the mucus for better clearance and are often found in
combination with decongestants. Some mucolytics are now available over the
counter. Saline spray or irrigation can help clear secretions. Topical corticosteroids
are not indicated for acute sinusitis but may be helpful for chronic sinusitis, nasal
polyps, and allergic and nonallergic rhinitis. Antihistamines are not indicated for
sinusitis but may be helpful for underlying allergic rhinitis.

37. PHARYNX
PHARYNGITIS

38. PHARYNGITIS
 Pharyngitis is inflammation of the pharynx, which is in the back of the
throat.
 Pharyngitis is an acute infection of the oropharynx or nasopharynx.
 It’s most often referred to simply as “sore throat.”
 Pharyngitis can also cause scratchiness in the throat and difficulty
swallowing.

39. ETIOLOGY
 Viral (42%)
Adenovirus (most common 31%)
EBV(6%)
Influenza virus(5%)
 Bacterial
Mixed infection common(48%)
beta-hemolytic streptococci (GABHS-38%)
H. influenza
staphylococcus aureus
Corynebacterium diphtheria
gonococcus
anaerobes remain uncertain.
 Fungal
Candida albicans

40. EPIDEMIOLOGY
 In India, it is estimated that approximately 7 sore throat
episodes occur per child per year
 There are as many as 20-30 million cases of streptococcal
pharyngitis which may occur annually in India.

41. PATHOPHYSIOLOGY
 The mechanism by which group A Streptococcus causes pharyngitis is not
well defined.
 Asymptomatic pharyngeal carriers of the organism may have an alteration
in host immunity (e.g., a breach in the pharyngeal mucosa) and the
bacteria of the oropharynx, allowing colonization to become infection.
 Pathogenic factors associated with the organism itself also may play a
role.
 These include pyrogenic toxins, hemolysins, streptokinase, and
proteinase.

43. Clinical MANIFESTATIONS
General
 A sore throat of sudden onset that is mostly self-limited.
 Fever and constitutional symptoms resolving in about 3 to 5 days.
 Clinical signs and symptoms are similar for viral causes as well as
nonstreptococcal bacterial causes.
Signs and symptoms
 Sore throat
 Pain on swallowing
 Fever
 Headache, nausea, vomiting and abdominal pain (especially children).
 Erythema/inflammation of the tonsils and pharynx with or without patchy
exudates.
 Enlarged, tender lymph nodes.
 Red swollen uvula, petechiae on the soft palate, and a scarlatiniform rash.
 Several symptoms that are not suggestive of group A streptococcus are cough,
conjunctivitis, coryza and diarrhea.

46. DIAGNOSIS
Physical exam
Throat culture
Blood tests
• Throat swab for C/S
• Rapid antigen testing against GABHS
• Kleb loeffler’s bacillus (KLB) (Corynebacterium diphtheriae)
• Leukocytosis
• Monospot test for EBV

48. PHARMACOLOGICAL THERAPY
 Antimicrobial therapy should be limited to those who have clinical and
epidemiologic features of group A streptococcal pharyngitis with a positive
laboratory test.
 Pencillin V K- 250mg, TD
 Pencillin benzathine- 1.2 million units IM OD
 Pencillin G procaine- only in children 1.2 million units, OD
 Amoxicillin- 500mg, TD
 Erythromycin Estolate- 20-40mg/kg/day
 Ethyl succinate- 40mg/kg/day
 Cephalexin- 250-500mg, PO, QD

49. RECURRENT EPISODES OF PHARYNGITIS
DRUG DOSE MECHANISM OF ACTION A.D.R
Clindamycin 600mg It is a bacterial protein synthesis inhibitor by
inhibiting ribosomal translocation
Abdominal pain, cramp
and rash
Amoxicillin+
clavulonate
500mg, BD It inhibits cross-linkage between the linear
peptidoglycan polymer chains that make up
a major component of the cell walls of both
Gram-positive and Gram-negative bacteria
Insomnia, confusion and
anxiety
Pencillin
benzathine
1.2 million units
IM
β-Lactam antibiotics inhibit the formation of
peptidoglycan cross-links in the bacterial
cell wall, but have no direct effect on cell
wall degradation
Diarrhea,
hypersensitivity, nausea
and rash
Pencillin
benzathine+
rifampin
1.2million units
IM+
20M/kg/day
The β-lactam moiety of penicillin binds to
the enzyme that links the peptidoglycan
molecules in bacteria. The enzymes that
hydrolyze the peptidoglycan cross-links
continue to function, which weakens the cell
wall of the bacterium.
Neurotoxicity, urticaria
and rash.

50. NON PHARMACOLOGICAL THERAPY
(Pt. counselling points)
 If a virus is causing your pharyngitis, home care can help relieve symptoms.
Home care includes:
 drinking plenty of fluids to prevent dehydration
 eating warm broth
 gargling with warm salt water (1 teaspoon of salt per 8 ounces of water)
 using a humidifier
 resting until you feel better
 For pain and fever relief, consider taking over-the-counter medication such
as acetaminophen or ibuprofen . Throat lozenges may also be helpful in
soothing a painful, scratchy throat.

51. LARYNGITIS AND LARYNGOTRACHEITIS
Laryngotracheobronchitis may affect people of any age, but it usually occurs
in children aged 6months to 6 years.
The peak incidence is in second year of life.
Thereafter, the enlarging caliber of the airway reduces the severity of the
manifestations of subglottic inflammation.
Vaccination has dramatically reduced rates of pertussis, including whooping
cough.

52. EPIGLOTTITIS
 Epiglottitis occurs at a rate of 6-14 cases per 100,000 children,
according to estimates from other countries.
 This condition typically occurs in children aged 2-7 years and has a
peak incidence in those aged 3 years.
 Epiglottitis is estimated to occur at annual incidence of 9.7 cases per
million adults.

53. LOWER RESPIRATORY TRACT
INFECTIONS

54. BRONCHITIS
•It is one of the top conditions for which patient seek medical care.
•Bronchitis is characterized by inflammation of the bronchial tubes, which are the
air passages that extend from the trachea into the small airway and alveoli.
•Triggers may be infectious agents, such as viruses or bacteria, or noninfectious
agents, such as smoking or inhalation of chemical pollutants or dust.
•Acute bronchitis is manifested by cough and occasionally sputum production
that last for no more than 3 weeks.
•Chronic bronchitis is defined clinically as cough with sputum expectoration for
at least 3 months during a period of 2 consecutive years.

55. ETIOLOGY
It is usually caused by infections, such as those caused by
 Mycoplasma species
 Chlamydia pneumoniae
 Streptococcus pneumoniae
 Moraxella catarrhalis
 Haemophilus influenza
And viruses such as
 Influenza
 Parainfluenza
 Adenovirus
 Rhinovirus
 Respiratory syncytial virus.

56. RISK FACTORS
 Smoking
 Exposed to second hand smoking
 Immunocompromised
 Elderly & Infants
 GORD
 Air pollution exposure
 Infectious agents

59. CLINICAL PRESENTATION
 Cough and sputum production (Cough is the most commonly
observed symptom).
 Sore throat
 Runny or stuffy nose
 Muscle aches
 Extreme fatigue
 Fever
 Nausea, vomiting and diarrhea.
 Dyspnea and cyanosis.

61. PHARMACOLOGICAL TREATMENT
Antibiotics
Preferred drugs
Usual Adult
Dose (mg)
MECHANISM OF ACTION A.D.R
Ampicillin 250-500mg It inhibits the third and final stage of
bacterial cell wall synthesis in binary
fission, which ultimately leads to cell
lysis.
Upset stomach, diarrhea,
vomiting
Amoxicillin 500-875mg This drug acts by inhibiting the
synthesis of bacterial cell walls
Nausea, vomiting, rashes
Amoxicillin-
Clavulanate
500-875mg It inhibits cross-linkage between the
linear peptidoglycan polymer chains
that make up a major component of the
cell walls of both Gram-positive and
Gram-negative bacteria
Insomnia, confusion and
anxiety
Ciprofloxacin 500-750mg It acts by inhibiting DNA gyrase, a
type II topoisomerase, and
topoisomerase IV, enzymes necessary
to separate bacterial DNA, thereby
inhibiting cell division.
Peripheral neuropathy,
Stevens-Johnson syndrome

62. Levofloxacin 500-750mg It acts by inhibiting DNA gyrase, a
type II topoisomerase, and
topoisomerase IV, enzymes
necessary to separate bacterial
DNA, thereby inhibiting cell
division.
Peripheral neuropathy,
hypersensitivity.
Moxifloxacin 400mg It acts by inhibiting DNA gyrase, a
type II topoisomerase, and
topoisomerase IV, enzymes
necessary to separate bacterial
DNA, thereby inhibiting cell
division.
Hepatitis, Stevens-Johnson
syndrome
Doxycycline 100mg They inhibit protein synthesis by
blocking the attachment of charged
aminoacyl-tRNA
Vomiting, diarrhea and
nausea.
Minocycline 100mg They inhibit protein synthesis by
blocking the attachment of charged
aminoacyl-tRNA
Upset stomach, diarrhea,
dizziness
Tetracycline HCL 500mg They inhibit protein synthesis by
blocking the attachment of charged
Nausea, vomiting

63. Supplemental Drugs
Azithromycin 250-500mg Azithromycin prevents bacteria from
growing by interfering with their protein
synthesis
Diarrhea, abdominal pain and
nausea
Erythromycin 500mg Erythromycin interferes with aminoacyl
translocation, preventing the transfer of
the tRNA bound at the A site of the rRNA
complex to the P site of the rRNA
complex
Diarrhea, nausea, abdominal
pain, and vomiting
Clarithromycin 250-500mg Clarithromycin prevents bacteria from
growing by interfering with their protein
synthesis
Extreme irritability, abdominal
pain and vomiting

65.  Pneumonia is a serious infection of the small bronchioles and alveoli that can involve
the pleura.
 It occurs in a variety of situations and treatment must vary according to the situation.
 It is classified as either community or hospital acquired depending on where the
patient contracted the infection.
 It is very life-threatening in the elderly or people with illnesses that affect the immune
system.
Community-acquired pneumonia (CAP) is one of the most common infectious diseases
addressed by clinicians. CAP is an important cause of mortality and morbidity
worldwide.

66. ETIOLOGY
 Streptococcus pneumonia
 Legionella species
 Mycoplasma pneumonia
 Chlamydia pneumonia
 Macmophilus influenza
 Staphylococcus aureus
 Chlamydia pneumonia

67. PATHOPHYSIOLOGY

69. PATHOPHYSIOLOGY (CAP)
 CAP is usually acquired via inhalation or aspiration of pulmonary pathogenic
organisms into a lung segment or lobe.
 Less commonly, CAP results from secondary bacteremia from a distant source,
such as Escherichia coli urinary tract infection and/or bacteremia.
 CAP due to aspiration of oropharyngeal contents is the only form of CAP involving
multiple pathogens.

70. Routes of Entry
 Aspiration
 Inhalation
 Colonization
 Hematogenous spread

71. Classification
 Community acquired pneumonia
 Nosocomial pneumonia (HAP)
 Aspiration pneumonia
 Immunocompromised host pneumonia

73. TREATMENT
Scenario Drugs Dose
Mild to moderate Amoxicillin 0.5gm, Q8h
Pneumonia Erythromycin 1-2gm, Q6h
Severe pneumonia Cefuroxime 7.50mg, Q8h
Pneumococcal disease Penicillin 500mg-2g/day
H.infleunza Amoxicillin 0.5gm, Q8h
Legionella species Erythromycin 250-500mg, Q6h
Eradication of the offending organism through selection of the appropriate antibiotic and complete
clinical cure are the goals of therapy for bacterial pneumonia.
S. pneumoniae- 7 to 10 days
Mycoplasma pneumoniae- 10 to 14
days
Chlamydia pneumoniae- 10 to 14
days
Duration of Therapy

74. REFERENCES
Text book of pharmacotherapy by JOSEPH T. DIPIRO, 1761- 1787.
Harrisons Manual of Medicine, 248- 254.
www.emedicine.medscape.com
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