rti

1. RESPIRATORY TRACT
INFECTIONS

2. Definition
Respiratory tract infection (RTI) is defined by any
infectious disease of upper or lower respiratory tract

3. Epidemiology
⚫Every year 3.9 million deaths occurs due to acute
respiratory tract infections in young children in world
⚫Among them 15%-30% deaths occurs in India

4. Types
Upper Respiratory Tract Infections
⚫Cold and Flu
⚫Influenza
⚫Pharyngitis (Sore throat)
⚫Acute Epiglottitis
⚫Otitis media
⚫Acute Sinusitis

6. Lower Respiratory tract infections
⚫Acute Bronchitis
⚫Bronchiolitis
⚫CommunityAcquired Pneumonia (CAP)
⚫HospitalAcquired Pneumonia (HAP)
⚫Cystic Fibrosis

8. Upper Respiratory Tract Infections
Disease Causative
Organism
Risk Factors Clinical
Presentation
Diagnosis
Cold and
Flu
 Rhino virus
 Corona virus
 Influenza virus
 Parainfluenza
virus
 Respiratory
syncytial virus
 Young children
 Elders
 Immunocomprimised
patients
 Running nose
 Sore throat
 Fever (Some
times)
 Body ache
 Headache
 Severe fatigue
Clinical
presentation

9. Upper Respiratory Tract Infections
Disease Causative
Organism
Risk Factors Clinical
Presentation
Diagnosis
Influenza Influenza
virus A, B
and C
 Winter
 Elders
 Long stay care facilities
 Carers
 Health care workers
 COPD patients
 CKD patients
 Diabetes patients
 Chronic liver disease patients
 Severe malaise
 Myalgia
 Cough
Clinical
presentation

10. Upper Respiratory Tract Infections
Disease Causative Organism Risk Factors Clinical
Presentation
Diagnosis
Pharyngitis
(Sore throat)
 Epstein Barr virus
 Streptococcus pyogenes
 Arcanobacterium
haemolyticum
 Neisseria gonorrhoea
 Cornybacterium
diphtheriae
 Travellers  Running nose
 Sore throat
 Fever
 Body ache
 Headache
 Severe fatigue
 Lymph node
enlargement
 White excudate
in tonsils
 Throat
swab
culture

11. Upper Respiratory Tract Infections
Disease Causative Organism Risk Factors Clinical
Presentation
Diagnosis
Acute
Epiglottitis
 H. influenzae
 Pneumococci
 Streptococci
 Staphylococci
 Children  Swollen
cherry red
epiglottis
 Fever
 Difficulty in
speaking and
breathing
 Droolong
Culture test

12. Upper Respiratory Tract Infections
Disease Causative Organism Risk Factors Clinical
Presentation
Diagnosis
Otitis media  S. pneumonia
 H. influenzae
 Influenza virus
 Rhinovirus
 Children  Ear pain
 Purulent
discharge
from ear
 Hearing loss
Culture test
Acute
Sinusitis
 S. pneumonia
 H. influenzae
 Influenza virus
 Rhinovirus
 Dental disease  Facial pain
 Tenderness
 Head ache
 Purulent nasal
discharge
Sinus
washout
culture

13. Lower Respiratory Tract Infections
Disease Causative Organism Risk Factors Clinical
Presentation
Diagnosis
Acute
Bronchitis
 Rhino virus
 Corona virus
 Influenza virus
 Adeno virus
 Bordetella pertusis
 Mycoplasma
pneumoniae
 Chlamydophilia
pneumoniae
 COPD
patients
 Productive
cough with
green or
yellow
sputum
Culture test

14. Lower Respiratory Tract Infections
Disease Causative
Organism
Risk Factors Clinical
Presentation
Diagnosis
Bronchiolitis  Respiratory
syncytial
virus
 Parainfluenz
a virus
 Rhino virus
 Adeno virus
 Children
 Newborn
babies
 Pre meature
babies
 Patients with
congenital
heart disease
 Fever
 Wheezing
•Rapid antigen
detection test
 Respiratory
distress
 Hypoxia
• Viral culture
of respiratory
secretions

15. Lower Respiratory Tract Infections
Disease Causative
Organism
Risk Factors Clinical
Presentation
Diagnosis
Community
Acquired
Pneumonia
(CAP)
 S.pneumoniae
 S.aureus
 H.influenzae
 Klebsiella
pneumoniae
 People live in
crowdy areas
 Blood stained
cough
 Dyspnea
 Fever
 Pleuritic chest
pain
 Consolidation in
lobes
 X-Ray
 Sputum
microscopy
 Sputum
cultureBronc
ho alveolar
lavage

16. Lower Respiratory Tract Infections
Disease Causative
Organism
Risk Factors Clinical
Presentation
Diagnosis
Hospital
Acquired
Pneumonia
(HAP)
 Enterobacteri
ciae
 Pseudomonas
 Acinobactor
 E.coli
 Klebseilla
 HCV
 Cytomegalay
virus
 candida
 Aspergillus
 ICU patients
 Stroke
patients
 Ventilated
patients
 Sepsis
 Respiratory
failure
 Sputum
culture
 Blood
culture
 Broncho
alveolar
lavage

17. Lower Respiratory Tract Infections
Disease Causative Organism Risk Factors Clinical
Presentation
Diagnosis
Cystic
Fibrosis
 S. aureus
 H. influenza
 P.aureginosa
 Infants
 Young
children
 Persistant
sputum
with cough
 Shortness
of breath
 Culture
test

18. Pathogenesis
Bacteria, Virus, and Fungi
Risk Factors Risk Factors
Enter in to Lower RTI
↓
Bronchi- Bronchitis
Bronchioles- Bronchiolitis
Alveoli- Pneumonia
Alveoli- Cystic Fibrosis
Enter in to Upper RTI
↓
Nasal tract- COLD
Nasal tract- Flu
Nasal tract- Influenza
Epiglottis- Epiglottitis
Pharynx- Phryngitis
Middle Ear- Otitis media
Sinus-Acute Sinusitis
Inflammatory changes in respiratory tract

19. ↓
Excess mucus production
↓
Hypoxia
↓
Structural damage to Respiratory tract
↓
Failure of exchange of gases
↓
Respiratory failure

21. Complications
Otitis media
⚫ Mastoiditis
⚫ Meningitis
⚫ Septecemia
Acute Sinusitis
⚫ Fronal bone osteomyelitis
⚫ Meningitis
⚫ Brain abscess
Pneumonia
⚫ Sepsis
⚫ Respiratory failure
Cystic Fibrosis
⚫ Bronchiectasis
⚫ Permenant lung disease

22. Non Pharmacological Treatment
⚫Vaccination
⚫Oxygen therapy
⚫Chest physiotherapy
⚫Ventilation
⚫Post operative mobilisation
⚫Lung transplantation

23. •Antipyretics
•Analgesics
•Antihistamines
Neuroaminadase
inhibitors
•Zanamivir-
Inhalor
•Oseltamavir-
oral Tab
Viral infection-
Self limited
Bacterial
infections-
Antibiotics
•Pencillins
•Cephalosporins
•Macrolides
Antibiotics
•Pencillins
•Cephalosporins
Antibiotics
•Pencillins
•Cephalosporins
Antibiotics
•Pencillins
•Cephalosporins
•Metronidazole
•Doxycycline
COLD&
Flu
Influenza
Pharyngitis
(Sore throat)
Otitis
media
Acute
Epiglottiti
s
Acute
Sinusiti
s
UPPER RTI

24. •Pencillins
•Cephalosporins
•Macrolides
•Tetracyclines
•Ribavarin
•Pencillins
•Cephalosporins
•Macrolides
Mild to Moderate
•Pencillin+
•Macrolide
Severe
•Cephalosporin+
Macrolide
•Coamoxyclav+
Macrolide
•Flucloxacillin
•Linezolid
Pencillin+
Aminoglycosides
or
Cephalosporins+
Aminoglycosides
or
•Fluroquinolones+
•Aminoglycosides
•Meropenam
or
•Teicoplanin
or
•Linezolid
or
•Vancomycin
•Flucloxacillin
•Macrolide
•Fluroquinolone
•Colistin nebuliser
Betalactum+Aminog
lycoside
Acute
Bronchiti
s
Bronchioliti
s
CAP HAP
Cystic
Fibrosis
LOWER RTI

25. Drugs used in treatment of RTI
Drug Category Mode of action Dose Adverse effects
Amoxicillin Pencillins Inhibit cell wall synthesis in
bacteria
250mg-TID
500mg-BD
875mg-BD
(Severe
Pneumonia)
 Anemia
 Hepatotoxicity
 GI disturbances
 Pseudomembranous colitis
Amoxiclav
Amoxicillin
+
Clavulanic acid
Inhibit cell wall synthesis in
bacteria
+
Prevents antibiotic
resistance
500/125mg-
BD/ TID
250/125mg-
875/125mg-
BD
 Diarrhea
 Mycosis
 CNS disturbances
 Candidiasis
 Vaginitis
Cephalexin Cephalosporin Inhibit cell wall synthesis in
bacteria
250mg-QID
500mg-BD
 Abdominal pain
 Anemia
 Angioedema
 Transaminitis
 Pseudomembranous colitis
Cefotaxime Cephalosporin Inhibit cell wall synthesis in
bacteria
1g- BD-IV
2g-TID-IV
 Pseudomembranous colitis
 Diarrhea
 Hepatotoxicity
 Nephrotoxicity
 Injection site pain
Ceftrixone Cephalosporin Inhibit cell wall synthesis in
bacteria
50mg/kg-OD  Induration at injection site
 Eosinophilia
 Thrombocytopenia
 Diarrhea
 Hepatotoxicity

26. Azithromycin Macrolides Inhibit protein
synthesis in bacteria
500mg-OD
First day
↓
250mg- OD
for 4 days
 GI disturbances
 Cramping
 Vaginitis
 Dyspepsia
 Agitation
Ciprofloxacin Fluroquinolone Inhibit protein
synthesis in bacteria
500mg-BD  GI disturbances
 Hepatoxicity
 Nephrotoxicity
 Restlessness
 Rashes
Linezolid Miscellaneous
antibiotic
Inhibit protein
synthesis in bacteria
600mg- BD  GI disturbances
 Diarrhea
 Hepatotoxicity
 Taste disturbances
 Tonugue discoloration
Meropenam Carbepenams Inhibit cell wall
synthesis in bacteria
500mg-TID for
five days
 GI disturbances
 Injection site reactions
 Phlebitis
 Bleeding
 Sepsis
Doxycycline Tetracyclines Inhibit protein
synthesis in bacteria
200mg-OD  Glossitis
 Teeth discoloration
 GI disturbances
 Esophagitis

27. Resources
⚫https://www.ncbi.nlm.nih.gov/pubmed/30921179
⚫https://www.ncbi.nlm.nih.gov/pubmed/30832720
⚫https://www.ncbi.nlm.nih.gov/pubmed/30612559
⚫https://www.ncbi.nlm.nih.gov/pubmed/30407312
⚫https://www.ncbi.nlm.nih.gov/pubmed/30329199