tailieunhanh - Chapter 128. Pneumococcal Infections (Part 8)

Acute Sinusitis Just as the pathogenesis and microbial etiology of acute rhinosinusitis are similar to those of otitis media, so are the principles of diagnosis and treatment. The diagnosis is often empirical, and the less rigorously it is made, the more irrelevant antibiotics are likely to be. The estimated efficacy rate for amoxicillin/clavulanic acid, fluoroquinolones, and ceftriaxone (available for parenteral use only) is 90–92%, as opposed to 83–88% for amoxicillin, trimethoprim-sulfamethoxazole, and oral secondor third-generation cephalosporins and 71–81% for macrolides and doxycycline. Treatment should be given for longer periods than are recommended for otitis media (perhaps 10–14 days), but the. | Chapter 128. Pneumococcal Infections Part 8 Acute Sinusitis Just as the pathogenesis and microbial etiology of acute rhinosinusitis are similar to those of otitis media so are the principles of diagnosis and treatment. The diagnosis is often empirical and the less rigorously it is made the more irrelevant antibiotics are likely to be. The estimated efficacy rate for amoxicillin clavulanic acid fluoroquinolones and ceftriaxone available for parenteral use only is 90-92 as opposed to 83-88 for amoxicillin trimethoprim-sulfamethoxazole and oral second- or third-generation cephalosporins and 71-81 for macrolides and doxycycline. Treatment should be given for longer periods than are recommended for otitis media perhaps 10-14 days but the optimal duration is uncertain. Pneumonia Table 128-5 This section will deal primarily with the treatment of pneumococcal pneumonia. The broader issue of empirical therapy for community-acquired pneumonia is covered elsewhere Chap. 251 . Unless epidemiologic clinical and radiologic findings strongly favor another etiology empirical therapy for pneumonia must include an agent that will be effective against S. pneumoniae which remains the most likely causative agent of community-acquired pneumonia. Table 128-5 Regimens for the Treatment of Pneumococcal Pneumonia in Adults Route Drug Dose Schedule Oral Therapy Amoxicillin 1 g q8h Quinolone . levofloxacin 500 mg q24h Telithromycin 800 mg q24h Parenteral Therapy Penicillinc 3-4 mU q4h Ampicillin 1-2 g q6h Ceftriaxone 1g q12-24h Cefotaxime 1-2 g q6-8h Quinolone . gatifloxacin 400 mg q24h Imipenem 500 mg q6h Vancomycin 500 mg q6h These regimens are recommended for treatment after a presumptive diagnosis of pneumococcal pneumonia is made on the basis of examination of

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