Respiratory Tract Infections

Pharmacotherapeutics of RTI

1. V.S.Swathi Assistant Professor VIPT, Duvvada RESPIRATORY TRACT INFECTIONS

2. Definition Respiratory tract infection (RTI) is defined by any infectious disease of upper or lower respiratory tract

3. Epidemiology Every year 3.9 million deaths occurs due to acute respiratory tract infections in young children in world Among them 15%-30% deaths occurs in India

4. Types Upper Respiratory Tract Infections Cold and Flu Influenza Pharyngitis (Sore throat) Acute Epiglottitis Otitis media Acute Sinusitis

5. Lower Respiratory tract infections Acute Bronchitis Bronchiolitis CommunityAcquired Pneumonia (CAP) Hospital Acquired Pneumonia (HAP) Cystic Fibrosis

6. Upper Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Cold and Flu Rhino virus Corona virus Influenza virus Parainfluenza virus Respiratory syncytial virus Young children Elders Immunocomprimised patients Running nose Sore throat Fever (Some times) Body ache Headache Severe fatigue Clinical presentation

7. Upper Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Influenza Influenza virus A, B and C Winter Elders Long stay care facilities Carers Health care workers COPD patients CKD patients Diabetes patients Chronic liver disease patients Severe malaise Myalgia Cough Clinical presentation

8. Upper Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Pharyngitis (Sore throat) Epstein Barr virus Streptococcus pyogenes Arcanobacterium haemolyticum Neisseria gonorrhoea Cornybacterium diphtheriae Travellers Running nose Sore throat Fever Body ache Headache Severe fatigue Lymph node enlargement White excudate in tonsils Throat swab culture

9. Upper Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Acute Epiglottitis H. influenzae Pneumococci Streptococci Staphylococci Children Swollen cherry red epiglottis Fever Difficulty in speaking and breathing Droolong Culture test

10. Upper Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Otitis media S. pneumonia H. influenzae Influenza virus Rhinovirus Children Ear pain Purulent discharge from ear Hearing loss Culture test Acute Sinusitis S. pneumonia H. influenzae Influenza virus Rhinovirus Dental disease Facial pain Tenderness Head ache Purulent nasal discharge Sinus washout culture

11. Lower Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Acute Bronchitis Rhino virus Corona virus Influenza virus Adeno virus Bordetella pertusis Mycoplasma pneumoniae Chlamydophilia pneumoniae COPD patients Productive cough with green or yellow sputum Culture test

12. Lower Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Bronchiolitis Respiratory syncytial virus Parainfluenza virus Rhino virus Adeno virus Children Newborn babies Pre meature babies Patients with congenital heart disease Fever Wheezing Respiratory distress Hypoxia Rapid antigen detection test Viral culture of respiratory secretions

13. Lower Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Community Acquired Pneumonia (CAP) S.pneumoniae S.aureus H.influenzae Klebsiella pneumoniae People live in crowdy areas Blood stained cough Dyspnea Fever Pleuritic chest pain Consolidation in lobes X-Ray Sputum microscopy Sputum cultureBroncho alveolar lavage

14. Lower Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Hospital Acquired Pneumonia (HAP) Enterobactericiae Pseudomonas Acinobactor E.coli Klebseilla HCV Cytomegalay virus candida Aspergillus ICU patients Stroke patients Ventilated patients Sepsis Respiratory failure Sputum culture Blood culture Broncho alveolar lavage

15. Lower Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Cystic Fibrosis S. aureus H. influenza P.aureginosa Infants Young children Persistant sputum with cough Shortness of breath Culture test

16. Pathogenesis Bacteria, Virus, and Fungi Risk Factors Risk Factors Enter in to Upper RTI Enter in to Lower RTI ↓ ↓ Nasal tract- COLD Bronchi- Bronchitis Nasal tract- Flu Bronchioles- Bronchiolitis Nasal tract- Influenza Alveoli- Pneumonia Epiglottis- Epiglottitis Alveoli- Cystic Fibrosis Pharynx- Phryngitis Middle Ear- Otitis media Sinus- Acute Sinusitis    Inflammatory changes in respiratory tract

17. ↓ Excess mucus production ↓ Hypoxia ↓ Structural damage to Respiratory tract ↓ Failure of exchange of gases ↓ Respiratory failure  

18. Complications Otitis media Mastoiditis Meningitis Septecemia Acute Sinusitis Fronal bone osteomyelitis Meningitis Brain abscess Pneumonia Sepsis Respiratory failure Cystic Fibrosis Bronchiectasis Permenant lung disease

19. Non Pharmacological Treatment Vaccination Oxygen therapy Chest physiotherapy Ventilation Post operative mobilisation Lung transplantation

20. Antipyretics Analgesics Antihistamines Neuroaminadase inhibitors Zanamivir - Inhalor   Oseltamavir - oral Tab Viral infection- Self limited B acterial infections- Antibiotics Pencillins Cephalosporins Macrolides Antibiotics Pencillins Cephalosporins Antibiotics Pencillins Cephalosporins Antibiotics Pencillins Cephalosporins Metronidazole Doxycycline COLD& Flu Influenza Pharyngitis ( Sore throat ) Otitis media Acute Epiglottitis Acute Sinusitis UPPER RTI

21. Pencillins Cephalosporins Macrolides Tetracyclines Ribavarin Pencillins Cephalosporins Macrolides   Mild to Moderate   Pencillin + Macrolide   Severe   Cephalosporin+ Macrolide Coamoxyclav + Macrolide Flucloxacillin Linezolid Pencillin + Aminoglycosides or Cephalosporins + Aminoglycosides or Fluroquinolones + Aminoglycosides Meropenam or Teicoplanin or Linezolid or Vancomycin Flucloxacillin Macrolide Fluroquinolone Colistin nebuliser Betalactum+Aminoglycoside Acute Bronchitis Bronchiolitis CAP HAP Cystic Fibrosis LOWER RTI

22. Drugs used in treatment of RTI Drug Category Mode of action Dose Adverse effects Amoxicillin Pencillins Inhibit cell wall synthesis in bacteria 250mg-TID 500mg-BD 875mg-BD (Severe Pneumonia) Anemia Hepatotoxicity GI disturbances Pseudomembranous colitis Amoxiclav Amoxicillin + Clavulanic acid Inhibit cell wall synthesis in bacteria + Prevents antibiotic resistance 500/125mg-BD/ TID 250/125mg- 875/125mg- BD Diarrhea Mycosis CNS disturbances Candidiasis Vaginitis Cephalexin Cephalosporin Inhibit cell wall synthesis in bacteria 250mg-QID 500mg-BD Abdominal pain Anemia Angioedema Transaminitis Pseudomembranous colitis Cefotaxime Cephalosporin Inhibit cell wall synthesis in bacteria 1g- BD-IV 2g-TID-IV Pseudomembranous colitis Diarrhea Hepatotoxicity Nephrotoxicity Injection site pain Ceftrixone Cephalosporin Inhibit cell wall synthesis in bacteria 50mg/kg-OD Induration at injection site Eosinophilia Thrombocytopenia Diarrhea Hepatotoxicity

23. Azithromycin Macrolides Inhibit protein synthesis in bacteria 500mg-OD First day ↓ 250mg- OD for 4 days GI disturbances Cramping Vaginitis Dyspepsia Agitation Ciprofloxacin Fluroquinolone Inhibit protein synthesis in bacteria 500mg-BD GI disturbances Hepatoxicity Nephrotoxicity Restlessness Rashes Linezolid Miscellaneous antibiotic Inhibit protein synthesis in bacteria 600mg- BD GI disturbances Diarrhea Hepatotoxicity Taste disturbances Tonugue discoloration Meropenam Carbepenams Inhibit cell wall synthesis in bacteria 500mg-TID for five days GI disturbances Injection site reactions Phlebitis Bleeding Sepsis Doxycycline Tetracyclines Inhibit protein synthesis in bacteria 200mg-OD Glossitis Teeth discoloration GI disturbances Esophagitis

24. Resources https://www.ncbi.nlm.nih.gov/pubmed/30921179 https://www.ncbi.nlm.nih.gov/pubmed/30832720 https://www.ncbi.nlm.nih.gov/pubmed/30612559 https://www.ncbi.nlm.nih.gov/pubmed/30407312 https://www.ncbi.nlm.nih.gov/pubmed/30329199