Essay 14- Antibiotics in pulmonology
- When should you use antibiotics?
- Only for bacterial infections
- How to distinguish between viral and bacterial infections
- Viral infections have persistent symptoms: symptoms last >10 days without improvement!
- Severe symptoms- high fever and purulent nasal discharge.
- Apparent improvement followed by sudden worsening after 3-4 days.
- Sinusitis
- Empirical treatment with amoxicillin or amoxicillin-clavulanate
- 10-14 days!
- Metronidazole may be added to increase anaerobic coverage
- Streptococcal pharyngitis
- Should be treated with either penicillin or amoxicillin
- 250mg twice or three times daily for children!
- 250mg 4 times daily for adults!
- For those with an allergy to penicillin, clindamycin, clarithromycin or azithromycin can be used
- Following antibiotic treatment, patients may see the resolution of symptoms within one to 3 days!
- Pneumonia
Empirical treatment of pneumonia (check local policy)5
3rd gen=3rd generation, eg cefotaxime, p379; gentamicin is an example of an aminoglycoside (p381).
Ticarcillin is an example of an antipseudomonal penicillin.
- Chronic bronchitis
- Antibioitics- macrolide therapy has been shown to have an anti-inflammatory property
- Not usually given!
- Bronchodilators- short and long acting as well as cholinergics
- Glucocorticoids- Reduce inflammation and mucus production. Given in inhaled form
- Phosphodiesterase-4 inhibitors- decrease inflammation and promote airway smooth muscle relaxation
- TB
- Drugs