Respiratory Infections treatment summaries Flashcards
epiglottitis
Cefotaxime (or ceftriaxone)
If history of immediate hypersensitivity reaction to penicillin or to cephalosporins, chloramphenicol
Bronchiectasis acute exacerbation
Oral first line:
Amoxicillin, clarithromycin, or doxycycline.
Alternative if at high risk of treatment failure (repeated courses of antibacterials, previous culture with resistant or atypical bacteria, or high risk of complications): co-amoxiclav, or levofloxacin (only if co-amoxiclav is inappropriate, and under specialist advice).
Intravenous first line (severely unwell or unable to take oral treatment):
Co-amoxiclav, piperacillin with tazobactam, or levofloxacin (only if co-amoxiclav and piperacillin with tazobactam are inappropriate, and under specialist advice).
COPD exacerbation
Oral first line:
Amoxicillin, clarithromycin, or doxycycline.
Alternative if at high risk of treatment failure (repeated courses of antibacterials, previous culture with resistant or atypical bacteria, or high risk of complications): co-amoxiclav, co-trimoxazole, or levofloxacin (only if co-amoxiclav and co-trimoxazole are inappropriate, and under specialist advice).
Oral second line (if no improvement after at least 2 to 3 days):
Use a first line antibacterial from a different class to the antibacterial used previously.
Alternative if at high risk of treatment failure: co-amoxiclav, co-trimoxazole, or levofloxacin (only if co-amoxiclav and co-trimoxazole are inappropriate, and under specialist advice).
Intravenous first line (severely unwell or unable to take oral treatment):
Amoxicillin, co-amoxiclav, clarithromycin, co-trimoxazole, or piperacillin with tazobactam.
Intravenous second line: Choice should be made in consultation with a local microbiologist.
Acute cough
The recommended duration of oral treatment is 5 days.
First line
Doxycycline.
Alternative first line choices: amoxicillin, clarithromycin, or erythromycin.
Choice during pregnancy:
Amoxicillin or erythromycin.
CAP
Low severity
Oral first line:
Amoxicillin.
Alternative in penicillin allergy or amoxicillin unsuitable (e.g. atypical pathogens suspected): clarithromycin, doxycycline, or erythromycin (in pregnancy).
Moderate severity
Oral first line:
Amoxicillin.
If atypical pathogens suspected: amoxicillin with clarithromycin or erythromycin (in pregnancy).
Alternative in penicillin allergy: clarithromycin, or doxycycline.
High severity
Oral or Intravenous first line:
Co-amoxiclav with clarithromycin or oral erythromycin (in pregnancy).
Alternative in penicillin allergy: levofloxacin (consult local microbiologist if fluoroquinolone not appropriate).
HAP
Non-severe signs or symptoms and not at higher risk of resistance
Oral first line:
Co-amoxiclav.
Alternative in penicillin allergy or co-amoxiclav unsuitable (based on specialist microbiological advice and local resistance data): doxycycline, cefalexin (caution in penicillin allergy), co-trimoxazole [unlicensed use], or levofloxacin [unlicensed use] (only if other antibacterials are inappropriate, and if switching from intravenous levofloxacin under specialist advice).
Severe signs or symptoms or at higher risk of resistance
Intravenous first line:
Piperacillin with tazobactam, ceftazidime, ceftazidime with avibactam, ceftriaxone, cefuroxime, meropenem, or levofloxacin [unlicensed use] (only if other first-line antibacterials are inappropriate).
If meticillin-resistant Staphylococcus aureus confirmed or suspected add vancomycin, or teicoplanin, or linezolid (under specialist advice only if vancomycin cannot be used).
Severe optic neuropathy may occur with the use of this antibiotic and as such visual function should be monitored regularly if treatment is required for longer than 28 days.
linezolid
Severe optic neuropathy may occur with the use of this antibiotic and as such visual function should be monitored regularly if treatment is required for longer than 28 days.
aztreonam
