Community-acquired bacterial infections

1. Community-acquired bacterial infections

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

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

4. Etiology: Streptococcus pyogenes anaerobic microbes (Peptostreptococcus sp.) ATB of I. choice: penicillin Alternative ATB: clindamycin Etiology andtreatmentofperitonsillarandtonsillarabscess

5. Pneumonia • typical • atypical • Pneumonia • community-acquired • hospital-acquired (nosocomial)

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

7. Etiology ofpneumonia atypicalpneumonia • Chlamydophilapneumoniae • Chlamydophilapsittaci • Mycoplasmapneumoniae • Legionellapneumophila • others

8. Accordingthe data fromolomouc region itispossible to make a conclusion: • typical pneumonias form about 65 % • atypical pneumonias form about 35 % • chlamydia pneumonias 24 % • mycoplasma pneumonias 11 %

9. Etiology ofpneumonia in children • Haemophilus influenzae • Mycoplasma pneumoniae (mainly in children 5 years old and older) • Streptococcus pneumoniae • Klebsiella pneumoniae

10. Accordingthe data fromolomouc region itispossible to make a conclusion (etiology ofpneumonia in children): • Haemophilus influenzae 36 % • Mycoplasma pneumoniae 25 % • Klebsiella pneumoniae 14 % • Streptococcus pneumoniae 11 % • others 14 %

11. Initialantibiotictherapyofcommunity-acquiredpneumonia • Drugof I. choice • amoxicillin • Alternativeantibiotics • macrolides (e.g. clarithromycin, azithromycin) • doxycycline (in adultsandchildrenolderthan 12 years)

12. 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 acuta

13. 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 otitis media chronica

14. 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 sinusitis acuta

15. 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 and treatment of epiglottitis

16. Etiology ofcommunity-acquiredurinarytractinfections • Escherichia coli • Proteus mirabilis • Enterococcus faecalis • Streptococcus agalactiae • others

17. Initial antibiotic therapy of community-acquired urinary tract infections • Drugof I. choice • nitrofurantoin, cotrimoxazol, trimethoprim, amoxicillin, oxolinicacid • Alternativeantibiotics • amoxicillin/clavulanicacid • ampicillin/sulbactam • cephalosporins II. gen. (cefuroxime, cefprozil)

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

19. Therapy in late-onset hospital-acquired pneumonia carbapenem (imipenem, meropenem) or -lactam/-lactamase inhibitor (piperacillin-tazobactam) event. + aminoglycoside (amikacin, gentamicin, tobramycin)