Community-acquired bacterial infections

The most frequent etiologic agents of bacterial tonsillitis and tonsillopharyngitis are Streptococcus pyogenes strains (80-90 %).

Initial antibiotic therapy of bacterial tonsillitis and tonsillopharyngitis Antibiotics of I. choice Antibiotics of I. choice – penicillin (3-4 x daily) – macrolides (in patients with allergy to penicillins)

Etiology and treatment of peritonsillar and tonsillar abscess Etiology: – Streptococcus pyogenes – anaerobic microbes (Peptostreptococcus sp.) ATB of I. choice: – penicillin Alternative ATB: – clindamycin

Pneumonia – typical – atypical Pneumonia – community-acquired – hospital-acquired (nosocomial)

Etiology of pneumonia – typical pneumonia Streptococcus pneumoniae Haemophilus influenzae Moraxella (Branhamella) catarrhalis Staphylococcus aureus Klebsiella pneumoniae other

Etiology of pneumonia atypical pneumonia  Chlamydophila pneumoniae  Chlamydophila psittaci  Mycoplasma pneumoniae  Legionella pneumophila  others

According the data from olomouc region it is possible to make a conclusion: typical pneumonias form about 65 % atypical pneumonias form about 35 % – chlamydia pneumonias 24 % – mycoplasma pneumonias 11 %

Etiology of pneumonia in children Haemophilus influenzae Mycoplasma pneumoniae (mainly in children 5 years old and older) Streptococcus pneumoniae Klebsiella pneumoniae

According the data from olomouc region it is possible to make a conclusion (etiology of pneumonia in children): – Haemophilus influenzae36 % – Mycoplasma pneumoniae 25 % – Klebsiella pneumoniae14 % – Streptococcus pneumoniae 11 % – others 14 %

Initial antibiotic therapy of community-acquired pneumonia Drug of I. choice Drug of I. choice – amoxicillin Alternative antibiotics Alternative antibiotics – macrolides (e.g. clarithromycin, azithromycin) – doxycycline (in adults and children older than 12 years)

Etiology and treatment of otitis media acuta Etiology: – Streptococcus pneumoniae – Haemophilus influenzae – Moraxella (B) catarrhalis Antibiotic of I. choice: – amoxicillin Alternative antibiotic: – amoxicillin/clavulanic acid – ampicillin/sulbactam – cephalosporins II. gen. (cefuroxime, cefprozil) – in patients with allergy to penicilllins - macrolides

Etiology and treatment of otitis media chronica Etiology: – gram-negative rods (Proteus sp., Pseudomonas aeruginosa) – Staphylococcus aureus – anaerobic microbes ATB of I. choice: – fluorochinolones (ofloxacin, ciprofloxacin) Alernative ATB: – gentamicin – ceftazidime – gentamicin+ceftazidime

Etiology and treatment of sinusitis acuta Etiology: – Streptococcus pneumoniae Haemophilus influenzae – Moraxella (B) catarrhalis Antibiotic of I. choice: – amoxicillin Alternative antibiotic: – amoxicillin/clavulanic acid – ampicillin/sulbactam – cephalosporins II. gen. (cefuroxime, cefprozil) – in patients with allergy to penicilllins - macrolides

Etiology and treatment of epiglottitis Etiology: – Haemophilus influenzae type b ATB of I. choice: – cephalosporins of III. generation – ampicillin – amoxicilin/clavulanic acid – ampicillin/sulbactam – cefuroxime Alternative ATB: – chloramfenikol (in case of allergy to penicillins)

Etiology of community-acquired urinary tract infections  Escherichia coli  Proteus mirabilis  Enterococcus faecalis  Streptococcus agalactiae  others

Initial antibiotic therapy of community- acquired urinary tract infections Drug of I. choice Drug of I. choice – nitrofurantoin, cotrimoxazol, trimethoprim, amoxicillin, oxolinic acid Alternative antibiotics Alternative antibiotics – amoxicillin/clavulanic acid – ampicillin/sulbactam – cephalosporins II. gen. (cefuroxime, cefprozil)

Hospital-acquired bacterial infections

Therapy in early-onset hospital-acquired pneumonia ampicillin/sulbactam or amoxicillin/clavulanic acid event. + gentamicin

Therapy in late-onset hospital-acquired pneumonia carbapenem (imipenem, meropenem) or piperacillin-tazobactam event. + aminoglycoside

Etiologic agents of HAP in ICUs (University Hospital Olomouc)