Recent update of Pneumonia and it's management

Recent update of Pneumonia

1. Recent Update on Pneumonia & It’s Management Dr. Md. Tanvir Islam Executive, Dept. of Medical Affairs Beximco Pharmaceuticals Ltd. Presented By

2. What is Pneumonia? Pneumonia is an inflammatory condition of the lung characterized by inflammation of the parenchyma of the lung (alveoli) abnormal alveolar filling with fluid causing air space disease (consolidation and exudation).

3. Epidemiology Pneumonia & influenza = 6th leading causes of death in the world Single most common cause of infection-related mortality Mortality rate: 1-5% out-Pt, 12% In-Pt, 40% ICU Death rates increase with comorbidity and age

4. Pneumonia: Classification Community-acquired pneumonia (CAP) Related to community Healthcare-associated pneumonia (HCAP) Pneumonia that develops within 48 hours of admission Hospital-acquired pneumonia (HAP) Pneumonia > 48 hours after admission Ventilator-associated pneumonia (VAP) pneumonia > 48 hours after intubation

5. Pathogenesis Inhalation, aspiration and hematogenous spread are the 3 main mechanisms by which bacteria reaches the lungs Primary inhalation : when organisms bypass normal respiratory defense mechanisms or when the Pt inhales organisms that colonize the upper respiratory tract or respiratory support equipment

6. Pathogenesis Aspiration : occurs when the Pt aspirates colonized upper respiratory tract secretions Hematogenous : originate from a distant source and reach the lungs via the blood stream.

7. Pathogenesis Micro-aspiration from nasopharynx: S. Pneumonia Inhalation: TB, Legionella Aspiration: anaerobic bacteria Bloodborne: Staph endocarditis Direct extension: trauma

8. Pathogens CAP usually caused by a single organism Caused by a variety of Bacteria, Viruses, Fungi Streptococcus pneumoniae is the most common pathogen 60-70% of the time

9. Pathogenic Organisms Outpatient Strep pneumo Mycoplasma / Chlamydophila H. influenzae Respiratory viruses Inpatient, non-ICU Strep pneumo Mycoplasma / Chlamydophila H. influenzae Legionella Respiratory viruses ICU Strep pneumo Staph aureus , Legionella Gram neg bacilli , H. influenzae

10. Who is at risk? CAP Alcoholics Smoking Chronic lung disease DM Residence in tropical developing country HAP Admission to burns unit or ICU Mechanical ventilation Length of hospital stay Surgery Wounds Previous infection Indwelling central intravenous or urinary catheters

11. Investigations CXR CBC Sputum gram stain, culture susceptibility Blood Culture ABG Urea / Electrolytes

12. Clinical Diagnosis: CXR Demonstrable infiltrate by CXR or other imaging technique CXR: classically thought of as the gold standard Establish Dx and presence of complications (pleural effusion, multilobar disease)

13. A chest X-ray showing a very prominent wedge shaped pneumonia in the right lung

14. Complications of Pneumonia Bacteremia Respiratory failure Pleural effusion (Parapneumonic effusion) Empyema Abscess

15. S. Pneumonia Preventive vaccine Pneumococcal conjugate vaccine (PCV) is a vaccine used to protect infants and young children Pneumococcal polysaccharide vaccine (PPSV)

16. Treatment Plan

17. Empiric outpt Management in Previously Healthy Pt Recommended : Advanced generation macrolide (azithromycin or clarithromycin); or Cephalosporin (cefixime) If within past 3 months : Respiratory quinolone (moxifloxacin, levofloxacin), OR Advanced macrolide + amoxicillin-clavulanate IDSA/ATS Guidelines

18. Empiric outpt Management in Pt with comorbidities Comorbidities : cardiopulmonary disease or immunocompromised state Recommended : Respiratory quinolone OR Advanced macrolide OR Cephalosporin Recent : Respiratory quinolone OR Advanced macrolide + beta-lactam IDSA/ATS Guidelines

19. Specific Treatment S. pneumonia: β-lactams Cephalosporins, eg. Ceftriaxone, Cefixime, Penicillin G Macrolides eg. Azithromycin Fluoroquinolone (FQ) eg. Levofloxacin Highly Penicillin Resistant: Linezolid

20. Pneumonia: Outpatient or Inpatient?

21. Inpatient Therapy: Pearls Give 1 st dose Antibiotics in ER (no specified time frame) Switch from IV to oral when pts are hemodynamically stable and clinically improving Discharge from hospital: As soon as clinically stable, off oxygen therapy, no active medical problems Duration of therapy is usually 10-14 days: Treat for a minimum of 5 days Before stopping therapy: afebrile for 48-72 hours, hemodynamically stable, RR <24

22. Proudly Presents To ensure effective treatment and fight against Pneumonia

23. Oral Cephalosporin with parenteral power *EFFECTIVE *SAFE *CONVENIENT Cefixime

24. Pneumonia URTI (Sinusitis, Pharyngitis and Tonsillitis) Surgical prophylaxis Acute Otitis Media Enteric fever Uncomplicated Urinary Tract Infections Switch therapy Indications

25. Why to choose Triocim? BECAUSE TRIOCIM IS EFFECTIVE SAFE CONVENIENT

26. Concentration maintained for longer time Ensures maximum killing and effectiveness against pathogens Drug concentration maintained for long 18 hours How Triocim is effective ?

27. Triocim in Pregnancy

28. How Triocim is convenient ?

29. Triocim is manufactured with the tough packaging Advanced Alu-Alu blister packaging for protects Cefixime from UV light

30. Products… Triocim 200 mg capsule Triocim 400 mg capsule Triocim powder for suspension (50 ml) Triocim DS powder for suspension (50 ml)

31. Also Presents

32. USFDA approved Clavulanic Acid combination. Diffuses rapidly into most of the body tissues & fluids, except for brain and spinal fluid. Long established safety tract in scientific studies & in practice. Ideal option for sequential therapy. Amoxicillin + Clavulanic Acid

33. Indication Dose Duration Guideline Respiratory tract infections 500 mg/125 mg TDS, or 875 mg/125 mg BD 7-10 days Otitis Media 250/125 mg three TDS or 500/125 mg TDS daily 5-7 days Skin and Skin Structure Infections 500 mg orally TDS Or 875 mg orally BD 5-7 days Urinary Tract Infections 625mg every 8 hours 7-10 days Bone and joint infections 500 mg orally TDS Or 875 mg orally BD 7-14 days

34. Why choose Original PREMIX formulation which ensures proper AMOXICILLIN & CLAVULANIC ACID dosing ratio. World class raw material from globally reputed manufacturer (FDA and EMEA approved source)

35. Your Patience Thank You For