Page 106 - Medicine and Surgery

P1: FAW
BLUK007-03 BLUK007-Kendall May 25, 2005 17:29 Char Count= 0

102 Chapter 3: Respiratory system

Table 3.10 Antibiotic therapy for pneumonia
Pneumonia Therapy
Community acquired Mild: Amoxycillin and erythromycin p.o.
Streptococcus pneumoniae 40% Severe: Cefuroxime or amoxycillin i.v. and erythromycin p.o., add flucloxacillin
if evidence of Staphylococcus aureus
Haemophilus influenzae 10%–30%
Moraxella catarrhalis 10%–30%
Atypical bacteria 10%–20%
Viral 10–20%
Gram negative organisms <1%
Nosocomial – hospital acquired Treatment should include a third generation cephalosporin such as
Gram negative (Klebsiella, E. Coli, ceftazidime. If severe sepsis or in a neutropenic patient combination
Pseudomonas, Proteus) 60% piperacillin/ tazobactam and gentamicin may be used
Strep. pneumoniae 5%
Staphylococcus aureus (including MRSA)

low blood pressure (systolic <90 mmHg or diastolic TB than non-immigrants. Worldwide the highest rates
≤60 mmHg). of tuberculosis are seen in sub-Saharan Africa, India,
Additional adverse features include: Age ≥ 50 years, China and the islands of Southeast Asia. Intermediate

coexisting chronic disease, hypoxia (PaO 2 < 8kPa or ratesoftuberculosisoccurinCentralandSouthAmerica,
oxygen saturation < 92%), bilateral or multilobe in- Eastern Europe and Northern Africa.
volvement on chest X-ray.
Ascore of 2ormorecorefeatures suggestaseverepneu- Aetiology
monia with indication for initial combined antibiotic M. tuberculosis is an acid fast aerobic bacillus that grows
therapy. slowly. It is spread by coughing up of live bacilli after
invasion of the disease into a main bronchus (open tu-
berculosis), which are then inhaled.
Tuberculosis The rising prevalence and mortality of tuberculosis is
thought to be related to the following:
Definition
Poverty and crowded conditions particularly in urban
Tuberculosis (TB) is a common chronic infectious dis-
environments.
ease caused by M. tuberculosis.
Relaxation of disease control programmes in the mid-

twentieth century when TB was declining.
Incidence
Approximately 7000 new cases a year in the United HIV co-infection.
Kingdom and rising throughout Europe and the United Theemergenceofmultipledrugresistanceduetonon-
States. compliance with medication.
Groups particularly at risk include the elderly, the very
Age young, alcoholics, immunosuppressed, e.g. organ trans-
Any age plant patients, chronic lung disease patients and hospital
workers.
Sex
M = F Pathophysiology
The cell wall of Mycobacterium contains complex lipids
Geography and glycolipids which sensitise T-cells to produce abun-
Risk of contracting TB is markedly greater in developing dant cytokines, which recruit macrophages (a Type IV
countries, immigrants to the United Kingdom from the hypersensitivity immune response). The macrophages
Asian sub-continent have a 40 times greater incidence of can phagocytose the organisms, but mycobacterial cell