The adequate standard of care in tract respiratory infection in daily practice
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THE ADEQUATE STANDARD OF CARE IN TRACT RESPIRATORY INFECTION IN DAILY PRACTICE
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The adequate standard of care in tract respiratory infection in daily practice
- 1. THE ADEQUATE STANDARD OF CARE IN TRACT RESPIRATORYINFECTIONSIN DAILY PRACTICE Dr MazenQusaibaty
- 2. Learning Objectives To review the role and indications of macrolides as preventive effects in respiratory disorders To review the treatment of Acute bronchitis To review the treatment of Community Acquired Pneumonia (CAP) 2
- 3. 3 Am J Med 2004; 117: Suppl. 9A, 5S–11S /Thorax 2002; 57: 657/ Curr Opin Infect Dis 2005; 18: 125–131.
- 4. 4 Am J Med 2004; 117: Suppl. 9A, 5S–11S /Thorax 2002; 57: 657/ Curr Opin Infect Dis 2005; 18: 125–131.
- 5. 5 Am J Med 2004; 117: Suppl. 9A, 5S–11S /Thorax 2002; 57: 657/ Curr Opin Infect Dis 2005; 18: 125–131.
- 6. 6
- 8. Summary of all studies 8
- 9. Summary of all studies A progressive inflammatory disorder of lung airways 9
- 10. Summary of all studies 10
- 11. Summary of all studies 11
- 12. Summary of all studies 12
- 13. Summary of all studies 13
- 14. Summary of all studies 14
- 15. SUMMARY
- 16. 16
- 17. Efficacy and Indication 17
- 18. Efficacy and Indication 18
- 19. Harmful 19
- 20. We are in the first steps to say in a loud voice Ok for Macrolides as immune modifying effects
- 21. Acute bronchitis in adults Most cases of acute bronchitis are due to viruses Lancet 1995; 345:665./ JAMA 1997 Sep 17;278(11):901-4/JAMA 1999 Apr 28;281(16):1512-9.
- 22. 22 Lancet 1995; 345:665./ JAMA 1997 Sep 17;278(11):901-4/JAMA 1999 Apr 28;281(16):1512-9.
- 23. 23 Lancet 1995; 345:665./ JAMA 1997 Sep 17;278(11):901-4/JAMA 1999 Apr 28;281(16):1512-9.
- 24. 24 Acute bronchitis is one of the most common causes of antibiotic abuse Lancet 1995; 345:665./ JAMA 1997 Sep 17;278(11):901-4/JAMA 1999 Apr 28;281(16):1512-9.
- 25. Influenza or Peumoniashould be considered Cough + sputum + fever Fever is relatively unusual inacute bronchitis 25
- 26. Simple upper respiratory infection 26
- 27. 27
- 28. Indications for a chest x-ray Pulse >100/min Respiratory rate >24 Temperature >38 ºC 28
- 29. Indications for a chest x-ray Rales or signs of consolidation on chest examination Patients over 75 years of age 29
- 30. Bacterial cultures of expectorated sputum Are not recommended 30
- 31. Patients with severe paroxysmal coughshould be evaluated for pertussis B pertussis only accounts for about 1 percent of cases of acute bronchitis in the US 31 N Engl J Med 2005 Oct 13;353(15):1555-63
- 32. Laboratory Diagnosis for B . PertussisNasopharyngeal secretions Culture PCR Direct fluorescent antibody test Serology (ELISA) blood 32 N Engl J Med 2005 Oct 13;353(15):1555-63
- 33. Laboratory Diagnosis for B . pertussis Sensitivity ? Specificity ? 33 N Engl J Med 2005 Oct 13;353(15):1555-63
- 34. Management of Acute Bronchitis 34
- 35. 35
- 36. 36 We recommend NOT treating patients with presumed acute bronchitis with empiric antibiotic therapy (Grade 1A) Lancet 1995; 345:665./ JAMA 1997 Sep 17;278(11):901-4/JAMA 1999 Apr 28;281(16):1512-9.
- 37. Community Acquired Pneumonia (CAP)
- 38. 38 TheDeadliestDiseases in the World /Source: The world health report 2004
- 39. 39 Clin Infect Dis 2007; 44:S27
- 41. Assessing the Severity of Illness 41 Lim, WS, van der, Eerden MM, Laing, R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58:377.
- 42. Medicine (Baltimore). 2007 Mar;86(2):103-11. 42
- 43. Medicine (Baltimore). 2007 Mar;86(2):103-11. 43
- 44. Medicine (Baltimore). 2007 Mar;86(2):103-11. 44
- 45. 45
- 46. 46
- 47. 47
- 48. Microbiology 48
- 49. Why we need Empirictherapy? 49
- 50. 50 Causes of community-acquired pneumonia in ambulatory patients Chest 2003; 123:1512 /Eur J ClinMicrobiol 1986; 5:446
- 51. 51
- 55. Risk factors for drug resistance Exposure to a child in a day care center
- 56. 55
- 57. 56
- 59. Outpatients / Management of CAP Clin Infect Dis 2007; 44 Suppl 2:S27
- 60. Outpatients / Management of CAP Clin Infect Dis 2007; 44 Suppl 2:S27
- 61. Outpatients / Management of CAP Clin Infect Dis 2007; 44 Suppl 2:S27 60
- 62. Outpatients / Management of CAP Clin Infect Dis 2007; 44 Suppl 2:S27
- 63. Outpatients / Management of CAP Clin Infect Dis 2007; 44 Suppl 2:S27 62
- 64. Outpatients / Management of CAP 63 ClinInfect Dis 2007; 44 Suppl 2:S27
- 65. Summary Clin Infect Dis 2007; 44 Suppl 2:S27
- 66. Management of Patients Who Are Hospitalized Inpatient
- 67. 66
- 68. 67 ICU patients Hospitalized patients Arch Intern Med 1997; 157:1709 / Ir J Med Sci 1989; 158:230/ Lancet 1982; 2:255/ Thorax 1991; 46:508/ Thorax 1991; 46:508 J Infect 1985; 10:204.
- 69. More than 6 months 1 month 3-6 months Post Transplantation Time-dependent course of infections in patients after transplantation 68
- 70. 69 (Grade 1B
- 71. Grade 2B
- 72. 71
- 73. 72 Mandell, LA, Wunderink, RG, Anzueto, A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44 Suppl 2:S27.
- 74. 73
- 76. 75
- 77. 76
- 78. 77
- 79. 78
Notas del editor
- If the score is zero we could treat the patient in homeIf the score is one we should treat the patient in hospital and if his the score is from 2-4 we should treat him in ICUMedline ® abstract for Reference 3of Treatment of community-acquired pneumonia in adults in the outpatient setting TI - Community-acquired pneumonia requiring admission to an intensive care unit: a descriptive study.AU - Marrie TJ; Shariatzadeh MRSO - Medicine (Baltimore). 2007 Mar;86(2):103-11.Severe community-acquired pneumonia (CAP) requiring admission to an intensive care unit (ICU) has been inadequately studied. We compared characteristics and outcomes of patients with CAP who were admitted to the ICU with those of patients managed on the ward. Of the 3675 patients hospitalized with CAP, 374 (10%) were admitted to the ICU. The main reason for ICU admission was respiratory failure requiring intubation and ventilation (n = 303, 81%), although this indication decreased with increasing age (p < 0.05 for trend). Most patients (62%) required mechanical ventilation for 3 days or less. The following factors were predictive of ICU admission on multivariable analysis: younger age, smoker, limitation of functional status, absence of cough or pleurisy, presence of chronic obstructive pulmonary disease, substance abuse, elevated serum creatinine, abnormal serum glucose concentration, and a respiratory rate of <16 or >24 breaths per minute. Patients with low Pneumonia Severity Index scores and low CURB-65 scores were admitted to the ICU based on clinical judgment that appeared to supersede objective scoring. Severe CAP requiring admission to the ICU is common, and the decision about which patients to admit often requires clinical judgment that in many cases appears at odds with various validated pneumonia severity scoring systems.AD - Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. tom.marrie@ualberta.ca
- If the score is zero we could treat the patient in homeIf the score is one we should treat the patient in hospital and if his the score is from 2-4 we should treat him in ICUMedline ® abstract for Reference 3of Treatment of community-acquired pneumonia in adults in the outpatient setting TI - Community-acquired pneumonia requiring admission to an intensive care unit: a descriptive study.AU - Marrie TJ; Shariatzadeh MRSO - Medicine (Baltimore). 2007 Mar;86(2):103-11.Severe community-acquired pneumonia (CAP) requiring admission to an intensive care unit (ICU) has been inadequately studied. We compared characteristics and outcomes of patients with CAP who were admitted to the ICU with those of patients managed on the ward. Of the 3675 patients hospitalized with CAP, 374 (10%) were admitted to the ICU. The main reason for ICU admission was respiratory failure requiring intubation and ventilation (n = 303, 81%), although this indication decreased with increasing age (p < 0.05 for trend). Most patients (62%) required mechanical ventilation for 3 days or less. The following factors were predictive of ICU admission on multivariable analysis: younger age, smoker, limitation of functional status, absence of cough or pleurisy, presence of chronic obstructive pulmonary disease, substance abuse, elevated serum creatinine, abnormal serum glucose concentration, and a respiratory rate of <16 or >24 breaths per minute. Patients with low Pneumonia Severity Index scores and low CURB-65 scores were admitted to the ICU based on clinical judgment that appeared to supersede objective scoring. Severe CAP requiring admission to the ICU is common, and the decision about which patients to admit often requires clinical judgment that in many cases appears at odds with various validated pneumonia severity scoring systems.AD - Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. tom.marrie@ualberta.ca
- If the score is zero we could treat the patient in homeIf the score is one we should treat the patient in hospital and if his the score is from 2-4 we should treat him in ICUMedline ® abstract for Reference 3of Treatment of community-acquired pneumonia in adults in the outpatient setting TI - Community-acquired pneumonia requiring admission to an intensive care unit: a descriptive study.AU - Marrie TJ; Shariatzadeh MRSO - Medicine (Baltimore). 2007 Mar;86(2):103-11.Severe community-acquired pneumonia (CAP) requiring admission to an intensive care unit (ICU) has been inadequately studied. We compared characteristics and outcomes of patients with CAP who were admitted to the ICU with those of patients managed on the ward. Of the 3675 patients hospitalized with CAP, 374 (10%) were admitted to the ICU. The main reason for ICU admission was respiratory failure requiring intubation and ventilation (n = 303, 81%), although this indication decreased with increasing age (p < 0.05 for trend). Most patients (62%) required mechanical ventilation for 3 days or less. The following factors were predictive of ICU admission on multivariable analysis: younger age, smoker, limitation of functional status, absence of cough or pleurisy, presence of chronic obstructive pulmonary disease, substance abuse, elevated serum creatinine, abnormal serum glucose concentration, and a respiratory rate of <16 or >24 breaths per minute. Patients with low Pneumonia Severity Index scores and low CURB-65 scores were admitted to the ICU based on clinical judgment that appeared to supersede objective scoring. Severe CAP requiring admission to the ICU is common, and the decision about which patients to admit often requires clinical judgment that in many cases appears at odds with various validated pneumonia severity scoring systems.AD - Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. tom.marrie@ualberta.ca