1. PHARMACOTHERAPY III PHCY 510
University of Nizwa
College of Pharmacy and Nursing
School of Pharmacy
PHARMACOTHERAPY III
PHCY 510
Lecture 5 Infectious Diseases “Lower Respiratory Tract Infections” Dr. Sabin Thomas, M. Pharm. Ph. D. Assistant Professor in Pharmacy Practice School of Pharmacy, CPN University of Nizwa

2. Course Outcome
Upon completion of this lecture the students will be able to
Describe pathophysiology, clinical presentation (signs and symptoms) diagnosis, investigations, treatment strategies, and follow up of bronchitis and pneumonia.
Individualize the antimicrobial treatments among bronchitis and pneumonia patients.

3. Lower respiratory tract infections include infectious processes of the lungs and bronchi, pneumonia, bronchitis, bronchiolitis, and lung abscess.
Bronchitis refers to an inflammatory condition of the tracheobronchial tree with a generalized respiratory infection.
Classified as either acute or chronic

4. Acute bronchitis occurs during winter months and begins as an upper respiratory infection.
Respiratory viruses are by far the most common infectious agents associated with acute bronchitis.
The common cold viruses, rhinovirus and coronavirus, and lower respiratory tract pathogens, including influenza virus, adenovirus, and respiratory syncytial virus.
Mycoplasma pneumoniae also appears to be a frequent cause of acute bronchitis.
Other bacterial causes include Chlamydia pneumoniae and Bordetella pertussis.

5. Clinical Presentation
Nonspecific complaints such as malaise and headache, coryza (inflammation of mucous membrane in the nose), and sore throat.
Cough is the hallmark of acute bronchitis initially nonproductive but progresses, yielding mucopurulent sputum.
Chest examination may reveal rhonchi and coarse, moist rales bilaterally.

6. Treatment M. pneumoniae treated with azithromycin or levofloxacin.
Mild analgesic-antipyretic therapy are often helpful in relieving the associated lethargy, malaise, and fever.
Acetaminophen (650 mg in adults or 10 to 15 mg/kg per dose in children).
Ibuprofen (200 to 800 mg in adults or 10 mg/kg per dose in children.
M. pneumoniae treated with azithromycin or levofloxacin.

7. Pneumonia Infection or inflammation of the lung parenchyma.
Of infective origin and characterized by consolidation (pus, bacteria, WBC and exudates filling alveoli and appear on chest x‐ray as opaque shadow).
Classified according to the nature of its acquisition as community acquired (CAP) or hospital acquired pneumonia (HAP)
Causative Organisms:
Typical: Streptococcus pneumonia and Haemophilus influenzae
Atypical: Ligionella pneumophila, Mycoplasma pneumonia, Chlamidophila pneumonia

8. Chest x‐ray showing severe, bilateral pneumonia

9. Community Acquired Pneumonia (CAP)
Diagnosis: sputum culture, bronchoscope lavage fluid for microscopy and culture. Atypical pneumonia is determined by serology
Targeted Treatment: Pneumococcus pneumonia benzylpenicillin, amoxicillin, erythromycin.
Combination of a beta‐lactam and a macrolides may reduce mortality
Chlamedophila pneumonia: doxycycline and quinolones
Staphylococcus spp.: flucloxacillin, vancomycin
Legionella (legionnaire’s disease): rifampicin, quinolones, azithromycin
Moderate to severe disease: hospital admission, combination of a beta‐lactam and a macrolide/doxycycline, moxifloxacin

10. Hospital Acquired Pneumonia (HAP)
(Nosocomial Pneumonia)
Causative organisms:
gram –ve bacilli (Enterobacter, Pseudomonas spp. And Acinetobacter spp.) and..
gram +ve cocci (S. aureus including MRSA)
Usually acquired in intensive care units (ICU) (50%) where broad spectrum antibiotics are used.
Clinical Features: nosocomial pneumonia accounts for 10‐15% of acquired infections- sepsis, respiratory failure.

11. Diagnosis: sputum, bronchoalveolar lavage and blood culture.
Predisposing factors include: stroke, mechanical ventilation, COPD, surgery, immunosupression and previous antibiotic use.
Diagnosis: sputum, bronchoalveolar lavage and blood culture.
Treatment: broad spectrum empiric therapy is indicated.
Influenced by previous antibiotics, surgery and duration of admission
Combination therapy include:
Aminoglycoside + penicillin / cephalosporin
Aminoglycoside + clindamycin
Vancomycin / linezolid + ciprofloxacin

12. Prevention:
Postoperative mobilization, physiotherapy, and rational antibiotic use.
Administration of aerosolized antibiotics for prevention of ventilator‐associated pneumonia.