common infections - Bpac.org.nz

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The following table is intended as a guide for selecting an appropriate antibiotic for infections commonly seen in general practice. Local resistance patterns and individual patient circumstances may alter the choice of antibiotic. Respiratory Acute bronchitis Management Common pathogens Antibiotic therapy Most acute bronchitis is of viral origin and therefore antibiotics are not indicated. Purulent sputum alone does not indicate the need for antibiotics. Antibiotics may be appropriate for those with co-morbidity or of advanced age. Respiratory viruses Less commonly: Bordetella pertussis, Mycoplasma pneumoniae, Chlamydophila pneumoniae Not usually indicated Acute exacerbation of chronic bronchitis Management Most exacerbations are likely to be viral and antibiotics are of limited benefit. Patients with severe exacerbations and those with more severe airflow obstruction at baseline are most likely to benefit from antibiotics. Common pathogens Antibiotic therapy First choice Alternatives Respiratory viruses, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis Amoxycillin 500 mg 3 times daily for 5 days Doxycycline 100 mg 2 times daily for 5 days Pneumonia – adult Management Common pathogens Antibiotic therapy First choice Consider chest x-ray to confirm diagnosis. The decision to treat with oral antibiotics as an outpatient depends on the age of the patient, co-morbidities and clinical signs indicating severity (HR > 100 bpm, RR > 24 bpm, temp. ≥ 38°C, signs of focal consolidation on examination). Respiratory viruses, S. pneumoniae, H. influenzae, M. pneumoniae, C. pneumoniae, Legionella pneumophila, Staphylococcus aureus Amoxycillin 1 g 3 times daily Plus either (to cover atypical infection): Roxithromycin 300 mg daily or Doxycycline 200 mg stat then 100 mg daily Duration of treatment is approximately 7 days. Alternatives Monotherapy with erythromycin, doxycycline or co-trimoxazole are alternatives for those with a history of penicillin allergy. N.B. Roxithromycin offers an alternative to erythromycin as they are both macrolide antibiotics. BPJ | Issue 21 | 21
Pneumonia – child Management Common pathogens Antibiotic therapy First choice Alternatives In a young child, suspect pneumonia if tachycardia, grunting, indrawing and high fever in absence of wheeze (auscultatory findings uncommon). The decision whether a patient receives inpatient or outpatient therapy depends on clinical severity. Patients who have systemic toxicity or any indication of respiratory failure should be treated in hospital. Respiratory viruses, S. pneumoniae, H. influenzae, M. pneumoniae Amoxycillin 25 mg/kg 3 times daily for 7 days Erythromycin If no response in 48 hours, review diagnosis and consider referral to hospital. Pertussis Management Community outbreaks of pertussis occur approximately every four years (see page 42). Notifiable disease. Antibiotics do not effect the course of the disease if they are given more than seven days after the illness has started. However, they may be justified during the first four weeks of the illness to limit transmission to susceptible contacts. Common pathogens Antibiotic therapy First choice B. pertussis Erythromycin 10 mg/kg (up to 500 mg) 4 times daily for 14 days Ear, nose and throat Otitis externa – acute or “swimmers ear” Management Common pathogens Antibiotic therapy First choice Alternatives Gentle debridement of the ear canal may be necessary to enhance the effectiveness of topical treatment. Suction cleaning is also a safe and effective method of debridement. Most topical antibacterials are contraindicated in the presence of a perforated drum or grommets. Pseudomonas aeruginosa, S. aureus, polymicrobial infections Clioquinol + flumethasone (Locorten Vioform) 2 to 3 drops 2 times daily or Dexamethasone + framycetin + gramicidin (Sofradex) 2 to 3 drops, 3 to 4 times daily. Acetic acid 2% (Vosol) or ciprofloxacin + hydrocortisone (Ciproxin HC) 22 | BPJ | Issue 21
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