Bronchitis Organism-Specific Therapy
No Results
No Results
processing….
Organism-specific therapeutic regimens for bronchitis are provided below . [1, 2, 3, 4, 5, 6, 7, 8]
See Bronchitis for full information.
Most acute bronchitis cases in healthy individuals do not have an identifiable cause; therefore, viral etiology is presumed. Nonetheless, some studies implicate bacterial pathogens in up to 25% of cases. [7]
Viral
Influenza virus (especially if associated with fevers, chills, headache, cough, and myalgias)
Oseltamivir 75 mg PO BID for 5 days or
Zanamivir 2 puffs (10 mg) inhaled BID for 5 days
Supportive measures for other viruses (eg, Parainfluenzavirus, respiratory syncytial virus, Coronavirus, Adenovirus, & Rhinovirus)
Bordetella pertussis (incubation period of 1-3 weeks, fever is uncommon, suspect if cough persists for >2 weeks): [6]
First-line treatment is macrolides:
Azithromycin 500 mg PO on day 1, then 250 mg PO q24h on days 2-5 or
Erythromycin 500 mg PO QID for 14 days or
Clarithromycin 500 mg PO BID for 7 days
Second-line treatment:
Trimethoprim-sulfamethoxazole (160 mg/800 mg) PO BID for 14 days
Mycoplasma pneumoniae (incubation period 2-3 weeks, gradual onset 2-3 days, occurs in clusters such as military or students): [6]
Azithromycin 500 mg PO on day 1 then 250 mg on days 2-5 or
Doxycycline 100 mg PO BID for 5 days or
Consider quinolones if local resistance to macrolides [10]
Chlamydophila pneumoniae (incubation period of 3 weeks, gradual onset of hoarseness before cough, occurs in clusters such as military, students, or nursing homes): [6]
Azithromycin 500 mg PO on day 1 then 250 mg on days 2-5 or
Doxycycline 100 mg PO BID for 5 days or
Supportive measures only
Other organisms identified to cause acute bronchitis include: Streptococcus pneumoniae, Haemophilusinfluenzae, and Moraxella catarrhalis. Treatment is below.
Always assess for regional resistance prior to choosing antimicrobial treatment.
Haemophilus influenzae & Haemophilus parainfluenzae: [8]
Amoxicillin/clavulanate 875/125 mg PO BID for 7-10 days or
Azithromycin 500 mg PO on day 1 then 250 mg on days 2-5 alternatively 500 mg PO daily for 3 days or
Cefuroxime 250-500mg PO BID for 10 days or
Levofloxacin 500 mg PO q24h for at least 7 days or
Moxifloxacin 400 mg PO q24h for 5 days or
Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12h for 10-14 days
Streptococcus pneumoniae: [8]
Amoxicillin 500 mg PO TID for 7-14 days or
Amoxicillin/clavulanate 875/125mg PO BID for 7-10 days or
Levofloxacin 500 mg PO q24h for at least 7 days or
Moxifloxacin 400 mg PO q24h for 5 days
Consider macrolides if local resistance is low.
Moraxella catarrhalis: [8]
Amoxicillin/clavulanate 875/125 mg PO BID for 7-10 days or
Azithromycin 500 mg PO on day 1 then 250 mg on days 2-5 alternatively 500 mg PO daily for 3 days or
Erythromycin 400 mg PO QID for 10 days or
Clarithromycin 250-500 mg PO BID for 7-14 days or
Cefuroxime 250-500 mg PO BID for 10 days or
Levofloxacin 500 mg PO q24h for at least 7 days or
Moxifloxacin 400 mg PO q24h for 5 days or
Ciprofloxacin 500 mg PO for 10 days or
Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12h for 10-14 days
Mycoplasma pneumoniae and Chlamydophila pneumoniae [6]
Macrolides and tetracyclines are drugs of choice:
Azithromycin 500 mg PO on day 1 then 250 mg on days 2-5 alternatively 500 mg PO daily for 3 days or
Erythromycin 400 mg PO QID for 10 days or
Clarithromycin 250-500 mg PO BID for 7-14 days or
Doxycycline 100 mg PO BID for 5 days or
Less active are fluoroquinolones:
Levofloxacin 500 mg PO q24h for at least 7 days or
Moxifloxacin 400 mg PO q24h for 5 days
Staphylococcus aureus [8]
For Methicillin-sensitive S aureus (MSSA):
Amoxicillin/clavulanate 875/125mg PO BID for 7-10 days or
Dicloxacillin 125-500 mg PO q6h taken on empty stomach or
Cephalexin 250 mg PO q6h
IV formulated antibiotics include: oxacillin, nafcillin, cefuroxime, and cefazolin
For methicillin-resistant S aureus (MRSA):
Clindamycin 600 mg PO TID for 14 days or
Linezolid 600 mg PO BID for 14 days or
Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12h for 14 days
IV formulated antibiotics include: vancomycin and daptomycin
Klebsiella pneumoniae [8]
Amoxicillin/clavulanate 875/125 mg PO BID for 7-10 days or
Cefuroxime 250-500 mg PO BID for 10 days or
Levofloxacin 500 mg PO q24h for at least 7 days or
Moxifloxacin 400 mg PO q24h for 5 days or
Ciprofloxacin 500 mg PO for 10 days or
Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12h for 10-14 days
IV formulated antibiotics include: ceftriaxone, gentamicin, amikacin, aztreonam, piperacillin/tazobactam, and imipenem/cilastatin.
Pseudomonas aeruginosa [8]
Levofloxacin 500 mg PO q24h for at least 14 days
Ciprofloxacin 500 mg PO for 14 days or
Consider IV formulations and double antimicrobial coverage if severely ill:
Piperacillin/tazobactam or ticarcillin/clavulanate
Meropenem or imipenem/cilastatin
See the list below:
Patients should receive the influenza vaccine yearly between October and December.
Patients aged 65 years or older or with chronic disease should receive pneumococcal vaccines; prevnar 13 and pneumovax 23, when possible prevnar 13 should be given first [9] .
Knutson D, Braun C. Diagnosis and management of acute bronchitis. Am Fam Physician. May 15 2002. 65(10):2039-44.
Wenzel RP, Fowler AA 3rd. Clinical practice. Acute bronchitis. N Engl J Med. Nov 16 2006. 355(20):2125-30.
Smucny J, Becker L, Glazier R. Beta2-agonists for acute bronchitis. Cochrane Database Syst Rev. Oct 18 2006. CD001726.
Tan T, Little P, Stokes T. Antibiotic prescribing for self limiting respiratory tract infections in primary care: summary of NICE guidance. BMJ. Jul 23 2008. 337:a437.
Siempos II, Dimopoulos G, Korbila IP, Manta K, Falagas ME. Macrolides, quinolones and amoxicillin/clavulanate for chronic bronchitis: a meta-analysis. Eur Respir J. Jun 2007. 29(6):1127-37.
Wenzel RP, Fowler AA 3rd. Clinical practice: Acute bronchitis. New England Journal of Medicine. November 2006. 355(20):2125-30.
Smith SM, Fahey T, Smucny J, Becker LA. Antibiotics for acute bronchitis. Cochrane Database Systemic Review. March 2014. 3:1-43.
Miravitlles M, Kruesmann F, Haverstock D, Perroncel R, Choudhri SH, Arvis P. Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis. European Respiratory Journal. June 2012. 39(6):1354-60.
Tomczyk S, Bennett NM, Stoecker C, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2014. 63:82.
AU Zhao F, Lv M, Tao X, Huang H, Zhang B, Zhang Z, et al. Antibiotic sensitivity of 40 Mycoplasma pneumoniae isolates and molecular analysis of macrolide-resistant isolates. Antimicrob Agents Chemother. 2012 Feb. 56(2:1108-9.
Jazeela Fayyaz, DO Pulmonologist, Department of Pulmonology, Unity Hospital
Jazeela Fayyaz, DO is a member of the following medical societies: American College of Physicians, American Thoracic Society
Disclosure: Nothing to disclose.
Ravikanth Vydyula, MD Fellow in Pulmonary and Critical Care Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital
Ravikanth Vydyula, MD is a member of the following medical societies: American College of Physicians, American Association of Physicians of Indian Origin
Disclosure: Nothing to disclose.
Maciej P Walczyszyn, MD Fellow in Pulmonary and Critical Care Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital; Hospitalist, Alliance Medical Group, Inc, Waterbury Hospital
Maciej P Walczyszyn, MD is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.
Klaus-Dieter Lessnau, MD, FCCP Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital
Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care Medicine
Disclosure: Nothing to disclose.
Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Nothing to disclose.
John J Oppenheimer, MD Clinical Professor, Department of Medicine, Rutgers New Jersey Medical School; Director of Clinical Research, Pulmonary and Allergy Associates, PA
John J Oppenheimer, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, New Jersey Allergy, Asthma and Immunology society
Disclosure: Received research grant from: quintiles, PRA, ICON, Novartis: Adjudication<br/>Received consulting fee from AZ for consulting; Received consulting fee from Glaxo, Myelin, Meda for consulting; Received grant/research funds from Glaxo for independent contractor; Received consulting fee from Merck for consulting; Received honoraria from Annals of Allergy Asthma Immunology for none; Partner received honoraria from ABAI for none. for: Atlantic Health System.
Bronchitis Organism-Specific Therapy
Research & References of Bronchitis Organism-Specific Therapy |A&C Accounting And Tax Services
Source
0 Comments