1. THE ADEQUATE STANDARD OF CARE IN TRACT RESPIRATORYINFECTIONSIN DAILY PRACTICE
Dr MazenQusaibaty

2. Learning Objectives
To review the role and indications of macrolides as preventive effects inrespiratory disorders
To review the treatment of Acute bronchitis
To review the treatment of Community Acquired Pneumonia (CAP)
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Am J Med 2004; 117: Suppl. 9A, 5S11S /Thorax 2002; 57: 657/ Curr Opin Infect Dis 2005; 18: 125131.
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Am J Med 2004; 117: Suppl. 9A, 5S11S /Thorax 2002; 57: 657/ Curr Opin Infect Dis 2005; 18: 125131.
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Am J Med 2004; 117: Suppl. 9A, 5S11S /Thorax 2002; 57: 657/ Curr Opin Infect Dis 2005; 18: 125131.
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7. Antipseudomonal activity

Erythromycin reduces P. aeruginosa adherence to Type 4 basement membrane collagen in vitroa. withouterythromycin

b. witherythromycin
Tsang et al, Eur Respir J 2003;21:401-6
8. Summary of all studies
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9. Summary of all studies
A progressive inflammatory disorder of lung airways
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10. Summary of all studies
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11. Summary of all studies
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12. Summary of all studies
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13. Summary of all studies
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14. Summary of all studies
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15. SUMMARY
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17. Efficacy and Indication
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18. Efficacy and Indication
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19. Harmful
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20. We are in the first steps to say in a loud voice
Ok for Macrolides as immune modifying effects
21. Acute bronchitis in adults
Most cases of acute bronchitis are due to viruses
Lancet 1995; 345:665./ JAMA 1997 Sep 17;278(11):901-4/JAMA 1999 Apr 28;281(16):1512-9.
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Lancet 1995; 345:665./ JAMA 1997 Sep 17;278(11):901-4/JAMA 1999 Apr 28;281(16):1512-9.
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Lancet 1995; 345:665./ JAMA 1997 Sep 17;278(11):901-4/JAMA 1999 Apr 28;281(16):1512-9.
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Acute bronchitis is one of the most common causes of antibiotic abuse
Lancet 1995; 345:665./ JAMA 1997 Sep 17;278(11):901-4/JAMA 1999 Apr 28;281(16):1512-9.
25. Influenza or Peumoniashould be considered
Cough + sputum +fever
Fever is relatively unusual inacute bronchitis
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26. Simple upper respiratory infection
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28. Indications for a chest x-ray
Pulse >100/min
Respiratory rate >24
Temperature >38 C
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29. Indications for a chest x-ray
Rales or signs of consolidation on chest examination
Patients over 75 years of age
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30. Bacterial cultures of expectorated sputum
Are not recommended
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31. Patients with severe paroxysmal coughshould be evaluated for pertussis
B pertussis only accounts for about 1 percent of cases of acute bronchitis in the US
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N Engl J Med 2005 Oct 13;353(15):1555-63
32. Laboratory Diagnosis for B . PertussisNasopharyngeal secretions
Culture
PCR
Direct fluorescent antibody test
Serology (ELISA) blood
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N Engl J Med 2005 Oct 13;353(15):1555-63
33. Laboratory Diagnosis for B . pertussis
Sensitivity ?
Specificity ?
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N Engl J Med 2005 Oct 13;353(15):1555-63
34. Management of Acute Bronchitis
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We recommend NOT treating patients with presumed acute bronchitis with empiric antibiotic therapy (Grade 1A)
Lancet 1995; 345:665./ JAMA 1997 Sep 17;278(11):901-4/JAMA 1999 Apr 28;281(16):1512-9.
37. Community Acquired Pneumonia (CAP)
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TheDeadliestDiseases in the World /Source: The world health report 2004
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Clin Infect Dis 2007; 44:S27
40. 41. Assessing the Severity of Illness
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Lim, WS, van der, Eerden MM, Laing, R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58:377.
42. Medicine (Baltimore). 2007 Mar;86(2):103-11.
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43. Medicine (Baltimore). 2007 Mar;86(2):103-11.
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44. Medicine (Baltimore). 2007 Mar;86(2):103-11.
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48. Microbiology
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49. Why we need Empirictherapy?
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Causes of community-acquired pneumonia in ambulatory patients
Chest 2003; 123:1512 /Eur J ClinMicrobiol 1986; 5:446
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52. Risk factors for drug resistance

Age > 65 years

53. Antimicrobial use 54. Alcoholism